LIBRARY OF CONGRESS. 

Chap Copyright No 

Shel£_;R£1 

UNITED STATES OF AMERICA. 



SECOND COPY, 



v'^R'D 



r ^ JUL 3-18.99 



HAY-FEVER 

AND 

ITS SUCCESSFUL TREATMENT 



HOLLOPETER 



Frontal sinus 



Orifice of the posterior ethmoidal cells 
Orifice of the sphenoidal sinus 
Sphenoidal sinus \ 



Orifice of middle ethmoidal cells 
Superior turbinal bone 

' i 




Orifice of 
frontal sinus 

Upper orifice 
of nasal duct 



Orifice of Eustachian j 

tube / 

Middle turbinal bone 

Inferior turbinal bone Orifice of the antrum Orifice of infundibulum 



Lower orifice of 
nasal duct 



Skction of the Nose, showing the Turbinal Bones and Meatuses, with the 
Openings in Dotted Outline. 



HAY-FEVER 



ITS SUCCESSFUL TREATMENT 



W. C. HOLLOPETER, A.M., M.D. 

clinical professor of pediatrics in the medico-chirurgical college 
of philadelphia ; physician to the methodist episcopal hos- 
pital ; pediatrist to the medico-chirurgical hospital, 
to st. Joseph's hospital ; fellow of the Ameri- 
can ACADEMY OF MEDICINE, ETC., ETC. 





f 



SeconD Bfcitfon, IRexusefc anD jEnlar^eD 



PHILADELPHIA 
P. BLAKISTON'S SON & CO. 

1012 WALNUT STREET 
1899 



* 



JO 






8465? 



Copyright, 1899, by P. Blakiston's Son & Co. 







WM. F. FELL & CO., 

ELECTROTYPERS AND PRINTERS, 

1220-24 SANSON! STREET, 

PHILADELPHIA. 



1 3S0S2 JUN9 



St er of con'^ v 




PREFACE. 



Having had remarkable and uniform success 
with a simple treatment of hay-fever for the last 
ten years, during which time I have given com- 
plete relief to over two hundred patients in my 
private practice, and having made a thorough 
clinical study of this affection, as well as an ex- 
haustive review of the literature relative to it, I 
feel justified in presenting the results of my 
labors in this short treatise. 

There is little to be said definitely about the 
etiology of the disease. It is undoubtedly caused 
by an external irritant, possibly containing a micro- 
organism or a toxin, which becomes especially 
active in the nasal passages of an individual pre- 
disposed by systemic debility or local abnor- 
mality. We acknowledge the element of neurotic 
disturbance, but to dogmatically define its exact 
cause and modus operandi is beyond us. 

v 



Vi PREFACE. 

In order that the best thought of the subject 
may be presented to the reader, I have compiled, 
arranged, and annotated the most worthy litera- 
ture, and I acknowledge my indebtedness to the 
many writers quoted. The most of my original 
communication is devoted to the all-important 
point in the discussion — the successful treatment. 
A complete bibliography is appended. 

W. C. HOLLOPETER. 

1428 North Broad Street, 
Philadelphia, July, 1898. 



PREFACE TO THE SECOND EDITION. 



Encouraged by the cordial reception of this 
little monograph, as evidenced by a call for a second 
edition within a year, the author has endeavored 
to revise and enlarge the text so as to include the 
special treatment of each of the various types of 
hay-fever cases. The bibliographic section has 
also been brought up to date. 

W. C. HOLLOPETER. 

1428 North Broad Street, 
Philadelphia, yz/^, i8gg. 



TABLE OF CONTENTS. 



PAGE 

Synonyms, ' . 9 

Definition, . 10 

General Remarks, 12 

History, 18 

Exciting Causes, 30 

Heat, 30 

Light, 32 

Dust, 34 

Ozone, Benzoic Acid, etc., 35 

Various Other Exciting Agents, 36 

The Pollen Theory, 41 

Predisposing Causes, 47 

Race, 47 

Geographic Distribution, 49 

Heredity, 52 

Sex, 54 

Age, 55 

Education, 55 

Occupation and Mode of Life, . 56 

The Neurotic Theory, 57 

Vasomotor Susceptibility, 59 

Idiosyncrasy, 60 

Local Disease Theory, 62 

The Uric Acid Theory, 64 

Defective Nutrition, 68 

Gastro-intestinal Causes, 7 1 

Time of Occurrence, 72 

vii 



Vlll TABLE OF CONTENTS. 

PAGE 

Duration, 76 

Symptoms, 78 

Complications and Sequelae, 84 

Pathology, 87 

Diagnosis, 94 

Prognosis, 98 

Treatment, 102 

General, 102 

Local, 107 

Prophylactic, Hygienic, and Systemic, 116 

Bibliography, 127 

Index, ...» 147 



HAY-FEVER. 



Synonyms. — Autumnal catarrh, Bostock's ca- 
tarrh, coryza vasomotoria, coryza vasomotoria 
periodica, hay-asthma, idiosyncratic coryza, June 
cold, July cold, nervous coryza, nervous catarrh, 
paroxysmal sneezing, peach cold, periodic hyper- 
esthetic rhinitis, pollen catarrh, pollen poisoning, 
pruritic catarrh, pruritic rhinitis, ragweed fever, 
rhinitis sympathetica, rhinitis vasomotoria, rose 
catarrh, rose cold, summer bronchitis, summer 
catarrh, summer catarrh from idiosyncrasy, sum- 
mer fever, typical early summer catarrh, vaso- 
motor coryza, vasomotor rhinitis. 

Latin eq. — Catarrhus aestivus, coryza vasomo- 
toria periodica. 

French eq. — Catarrhe d'ete, catarrhe de foin. 

German eq. — Fruhsommerkatarrh, Heuasthma, 
Heufieber. 

Italian eq. — Asma dei mietitori, febbre del fieno, 
asma del fieno. 

9 



10 HAY-FEVER. 

Definition. — The term " hay-fever " was first 
used to designate the form of disease occurring 
in the autumn in distinction from like affections 
which occur in other seasons. So universal, 
however, has become its use that it is now 
employed to designate all the forms of what 
may be called the periodic influenzas, irrespective 
of seasons. 

Hay-fever may be defined as an affection of the 
upper air-passages occurring periodically, usually 
at or near a fixed date in the early autumn, some- 
times in the spring or summer, characterized by its 
sudden onset and as sudden termination in certain 
atmospheric conditions, by swelling and tumes- 
cence of mucous membranes of the nasal fossae and 
adjacent cavities, irritating discharges therefrom, 
and various symptoms of coryza, and occasionally 
by asthmatic paroxysms. It always results from the 
combination of a special predisposition, from de- 
praved resistance or lowered vitality of the general 
system or a local lesion, and an exciting cause, 
believed to be a micro-organism or peculiar toxin, 
generally arising from pollen or dust deposited 
upon or in the mucous membrane of the upper air- 
passages. The important predisposing causes are : 



DEFINITION. I I 

heredity, idiosyncrasy, neurotic temperament, 
peculiar susceptibility of the vasomotor system, 
generally debilitated condition, deranged assimi- 
lation, and a local lesion. Hay-fever has been 
defined as a neurosis, as an idiosyncrasy, as a 
catarrhal affection, and as a type of influenza, and 
as various combinations of these. The deposition 
of some special irritant is universally regarded as 
the exciting cause. 



12 HAY-FEVER. 



GENERAL REMARKS. 

The idea of an external irritant in hay-fever 
pervades most views of it. There can be no doubt, 
however, that there is usually an underlying sys- 
temic condition which renders individuals sus- 
ceptible to the disease. It may, in addition, be 
accepted as conclusive that the nasal abnormali- 
ties found in hay-fever subjects are as often inci- 
dental as causative. They are seldom exclusively 
provocative of the susceptibility, and they are not 
the results of repeated attacks. Exactly what 
this underlying condition of susceptibility is has 
been variously regarded. The nature of the irri- 
tant has been widely and scientifically investigated. 
While all theories advanced are in part more 
or less tenable, none of them alone is satisfac- 
tory. The condition is always, however, one of 
lowered resistance, general or local. If general, 
it may be of neurotic, lithemic, idiosyncratic, 
gastric, intestinal, or diathetic origin. It is, 
therefore, my belief, that in hay-fever there is 
always, first, an exciting agent, and, second, a 
system predisposed by debility of some character 



GENERAL REMARKS. I 3 

to the influence of this irritant. The overwhelming 
testimony as to the character of this irritant points 
to its derivation from something external to the 
body of the sufferer. Moreover, it is absolutely 
certain that without the action of an external irri- 
tant genuine hay-fever does not occur. The elab- 
orate and ingenious experiments of Blackley, not 
only upon himself but upon other individuals, 
clearly indicated the pollen of flowering plants as 
an active, exciting cause. It has never been shown 
that, although pollen, healthy or unhealthy, may 
be a mechanical irritant and thus account for many 
cases, it is not also a chemic irritant when it 
has fallen upon a susceptible soil. It has been 
claimed that hay-fever is caused by a toxin gener- 
ated by a fermentative process in the pollen which 
has fallen into the alkaline solution of the nose ; 
and it has been shown that acid solutions stop the 
movements of many micro-organisms and sperma- 
tozoa, and that alkaline solutions in the nares have 
given little or no benefit in attacks of hay-fever. 
It has also been shown that the affection is more 
common among men than among women, and that 
the blood of the latter is the less alkaline. 

Arnold, in 1896, stated that just what constitutes 



14 HAY-FEVER. 

the irritant is not determined, and said it is likely 
that not healthy pollen but some fungoid growth 
is responsible, since threshers of grain, at other 
times without ill-effects, have complained of attacks 
of hay-fever after threshing smutty or moldy 
grain, especially oats. 

Helmholtz, himself a sufferer from hay-fever, 
discovered peculiar micro-organisms in his nasal 
discharges. These vibrios were never found by 
others, and this fact is supposed to controvert his 
theory. It has not been shown conclusively that 
they have been sought for by other investigators, 
and it is likely that they have not, since attention 
has been called away by the pollen and other 
theories. The antiseptic quinin solution employed 
by Helmholtz, while extensively used with good 
results for the subsequent decad, was not invari- 
ably accompanied by relief. Later, the relief that 
was given by quinin solutions was said to be 
psychic. This allegation may well be understood 
when it is considered that many other theories as to 
the causation of hay-fever, particularly the pollen, 
abounded soon after Helmholtz's expositions. 

Some very interesting investigations by Strang- 
ways, of St. Louis, in 1897, urged him to conclude 



GENERAL REMARKS. I 5 

that the amount of pollen in the air is altogether 
too small to have an injurious mechanical, medici- 
nal, or poisonous influence. He calculates that for 
every square foot of surface there is one ragweed,^ 
and inquiry showed that mere elevation of several 
hundred feet above the earth's surface does not 
give relief from this distressing affection. Strang- 
ways found that ragweed pollen probably floats to 
iooo feet elevation ; but, if the limit is placed at 
500 feet, it would give for every plant 500,000 
cubic feet of air, not for one day but for six weeks ; 
1. e. 9 if the whole plant was pollen there would be 
still only one part of pollen to fifteen or twenty 
billion parts of air. The rose and the golden-rod 
are in even smaller quantities. Strangways' 
estimates showed that there was not more than 
one grain of pollen for every thirty respirations. 
He advanced the theory that, while pollen plays 
a part, it does not irritate mucous membrane nor 
produce vasomotor paresis by its direct influence, 
but that a protoplasmic substance found in 
pollen and in the vegetable kingdom, acting as 
a ferment, causes the formation of a toxin which 
is the real exciting cause. 

There can be little doubt that the neurotic ele- 



1 6 HAY-FEVER. 

ment has been present in many, if not most, cases 
of hay-fever, and evidenced by depression, general 
lowering of tone, or exhaustion of the nervous 
system. The neurosis need not be acquired ; in 
fact, it is often hereditary, which w r ill be discussed 
later. 

Holmes believes the disease to be in great part 
a neurosis with other debilitating conditions. The 
fact that the better educated classes are most prone 
to this affection indicates the influence of neurotic 
tendency as well as exhaustion of the nervous 
system or debility or depression thereof. The 
premonitory symptoms of this affection, as ably 
shown by Sajous, show the neurotic elements. 
He well asks, " If the local irritant is the only 
cause, why does the respiratory tract, the portion 
of the body first and most exposed to its effects, 
not become immediately influenced ? " This au- 
thor also shows a case following enteric fever, 
the debilitating and exhaustive character of which 
is well known, one preceded by malarial fever and 
another by bronchitis, pertussis, and varicella. 

Of the various other theories advanced are the 
lithemic, the intestinal or gastric, due to lack of 
proper assimilation, and the uric acid diathesis. 



GENERAL REMARKS. \J 

The views herein advanced are not at all inconsis- 
tent with the idea that the diatheses exercise a 
predisposing influence in producing the affection, 
which influence is debilitating and devitalizing. 

The local theory alone is not conclusive nor 
satisfactory; viz., that the disease is due to chronic 
nasal catarrh, or a local lesion, upon which the 
exciting cause acts. There is no doubt that dis- 
eased areas are more sensitive to the irritant, and 
especially so in cases of lowered vital energy and 
lessened normal resistance, general or local ; but 
a large number of cases show no local disease. 

In all of the theories respecting this affection 
there is more or less regard for the agency of 
pollen in provoking the paroxysms of the disease ; 
but as every one is exposed to the irritant, in those 
affected the soil must be prepared for the seed, 
that is, before the deposition of the pollen or dust 
or exciting agent there must be a morbid condi- 
tion preexisting, which can so far be characterized 
as to call it lowered vitality or general or local 
resistance, which springs from a variety of causes. 



HAY-FEVER. 



HISTORY. 

Exactly when hay-fever was recognized as a 
distinct affection is not known. Beschorner shows 
that it was known in the sixteenth century. In 
1565 Botallus reported a case. Van Helmont 
and Binninger in the seventeenth century speak 
of it. A similar distressing catarrhal affection, 
but due to the rose, is instanced in " Acta nat. 
curios. Ephemerides," Dec. II, Ann. V, obs. 22, 
and again in the same journal, Dec. Ill, Ann. V 
and VI, obs. 193, a case of annually recurring 
profuse nasal catarrh is mentioned. John Floyer, 
London, 1698, noticed that there were peculiar 
cases of asthma in which the attacks were longer 
and more acute in summer than in winter. In 
Good's " Study of Medicine " there is a reference 
to a case related by Timaeus in 1667, of an attack 
of an asthmatic nature caused by the odor of 
roses and ipecac. Riedlin, in his " Lin. Med.," 
p. 177, in 1695, wrote of the odor of roses 
causing a catarrh of the head, resembling hay- 
fever. C. L. Parry, of London, records a case in 
1809 and another in 181 1. Elliotson, in 1821, 



HISTORY. 19 

tells of a patient who had had hay-fever since 
1789, and of another who was sixty-six years 
of age and who had had the disease from his 
seventh year, i. e. y since 1755, and of a third who 
had been afflicted for many years. 

Just when and where the term " hay-fever " or 
u hay-asthma " arose it is impossible to say, but 
probably it was popularly so named. The emana- 
tions from dry hay were first thought to have 
caused it. Dr. Bostock, who was himself a suf- 
ferer, in 1 8 19, found that the laity knew of the 
affection, although it was not recognized as a 
distinct disease by the profession. He objected 
to the term u hay-fever/' which was already em- 
ployed to designate it in his day, contending that 
moist heat, sunshine, dust, and* fatigue were 
more potent in its causation than emanations from 
dry hay. It seems remarkable that the profession 
in England were unfamiliar with hay-fever as a 
distinct affliction, especially as their king, George 
IV, was a sufferer from it. In 1828 Bostock, who 
had first described the disease to the Medico- 
Chirurgical Society of London as a " case of a 
periodic affection of the eyes and chest," pub- 
lished some further observations on the complaint 



20 HAY-FEVER. 

under the title " Summer Catarrh," or " Catarrhus 
yEstivus." In 1828 MacCulloch included it in 
his " An Essay on the Remittent and Intermittent 
Diseases," but advanced no special views. In 
1830 Augustus Prater published notes of a case 
seen in Paris. In 1831 Dr. Elliotson, in London, 
briefly described the affection; and in 1833 he 
discussed the complaint more fully and opposed 
Bostock's theory of heat and rejected the hay- 
theory of its origin, but declared grasses to be 
more important factors ; and he first pointed to 
pollen as the probable cause of the disease. In 
1847 Dr. Ramadge detailed reports of cases and 
believed " effluvia from flowers " caused it. In 
1850 Gream first alluded to dust as an exciting 
cause and proposed nux vomica as a remedy. In 
1852 Dr. Laforgue, of Toulouse, wrote his essay 
"Observation de catarrhe d'ete," in which he up- 
held heat as the cause, after the view of Bostock. 
But in the next year, 1853, in " L'Abeille Medi- 
cale," an anonymous contributor, reciting his own 
case, advocated hay-emanations and not heat as 
the exciting agent. In 1854 Phoebus, of Giessen, 
concluded from his study of 154 cases that sun- 
light was the active cause of the attacks. In 



HISTORY. 21 

1857 Watson ascribed the malady to the presence 
of vegetable matter in the atmosphere. In 1859 
Phoebus again published the results of his circu- 
lar of inquiry. He went into the subject more 
thoroughly than any of his predecessors, and 
from sunlight he shifted to ozone as the theoretic 
cause of the malady. In this same year Hyde 
Salter named as the exciting agents "bright, hot, 
dusty sunshine," a full meal, and hay, and recited 
two interesting cases. Another writer, Walshe, in 
the same year, referred to hay-fever as a singular 
variety of nasopulmonary catarrh, and he first 
called attention to the fact that the disease, in his 
own person, " always disappeared in crossing the 
Atlantic." 

In July, i860, Dr. Cornaz, of Neufchatel, Switz- 
erland, in a paper on hay-fever, described six 
cases, and concluded that the flowers of grasses 
were the cause of the disease, and he was followed 
on the 20th of August of the same year by Dr. 
Labosse, of Nitry, France, in a paper entitled 
" Nouvelle Observation de Catarrh de Foin," in 
which he spoke of three persons whose symptoms 
occurred at the time certain flowers were in bloom. 
In 1866 strong light and great heat were ad- 



22 HAY-FEVER. 

vanced as aggravating causes by Dr. Wm. Abbotts 
Smith. In his published work, " On Hay-fever, 
Hay-asthma, or Summer Catarrh," he rejected the 
ozone theory of Phoebus. 

In 1867 the nervous origin of the disease was 
first advanced by Dr. William Pirrie, who spoke 
of two forms, — one a spasmodic form caused by 
external irritants, the other arising from the action 
of light and heat upon the central nervous, the 
cerebrospinal, and sympathetic systems. In the 
same year, Helmholtz, who, though not a general 
practitioner, while suffering from hay-fever, began 
to treat it with a quinin solution and found that 
he was relieved thereby. Two years later he de- 
tailed to C. Binz, of Bonn, Germany, by letter, the 
history of his sufferings, and recommending his 
solution as a ready means of relief and even of 
prevention, which was in accord with the findings 
of Binz that the quinin solution was poisonous to 
infusoria. In this letter Helmholtz propounded 
the theory that the symptoms were caused by 
vibrios which, though latent at other times in the 
nasal fossae and sinuses, were excited to activity 
by the heat of summer. It has since been thought 
that the organisms found by Helmholtz, by means 



HISTORY. 23 

of the microscope, in the nasal discharges during 
an attack were probably fragments of mycelium- 
like threads which develop from pollen-cells under 
the influence of the heat and moisture of the nasal 
chambers and which contain the minute fovilla of 
the pollen-cells. The use of the quinin solution 
which Helmholtz so successfully employed on 
himself became very popular and found many 
strong advocates in the profession until the exten- 
sive researches of Blackley in regard to pollen in 
1873. In the meantime, in 1870, Dr. George 
Moore advocated a complex theory of the disease, 
really combinations of preceding theories. In the 
same year Roberts issued a short, practical paper, 
claiming to be the first to observe excessive cold- 
ness of the tip of the nose as the " pathognomonic " 
symptom of hay-fever and desiring credit to be 
accorded him for this discovery. 

In 1872 Morrill Wyman, of Cambridge, Mass., 
distinguished two different forms of the disease; 
naming that occurring in August "autumnal 
catarrh," peculiar to America, and that of the 
spring or early summer "June cold" or "rose 
cold," more prevalent in England. 

Dr. Wyman first attempted to define the geo- 



24 HAY-FEVER. 

graphical limits of the disease, and called atten- 
tion to the important fact that residence in certain 
elevated regions brought certain and complete 
relief in most cases of autumnal catarrh. He 
stated that a lady from Lynn, Mass., a great 
sufferer, accidentally observed in 1853 that her 
catarrh passed by while she was traveling in the 
White Mountains, and that for the following ten 
years she visited the region and escaped the disease. 
In i860 Jacob Horton,of Newburyport, Mass., wrote 
Dr. Wyman that the White Mountains gave the 
only relief. In 1873 Charles H. Blackley, of Man- 
chester, endeavored to show that pollen mainly, if 
not exclusively, caused the malady, and by exten- 
sive experiments showed that the amount of pollen 
in the atmosphere at great elevations was to that 
in the air at ordinary breathing levels as nineteen 
to one. He proved, by very ingenious and care- 
fully conducted series of experiments, that the 
pollen of grasses and flowers was the sole cause 
of hay-fever in himself, and that in two other 
patients the severity of the attacks was directly 
related to the amount of pollen in the air. His 
subsequent observations made it extremely prob- 
able that pollen is an important factor in the 



HISTORY. 25 

causation of hay-fever, although all kinds of dust 
may be sufficiently irritating to excite the par- 
oxysms. This was in opposition to the views of 
Phoebus and of Pirrie, both of whom suggested 
heat, strong light, and ozone as the exciting causes. 
Pirrie had also suggested disturbance of the 
central nervous system as an important etiologic 
factor. He was supported in this view in 1876 by 
Morrill Wyman, then of New York. In the same 
year Beard, of New York, published his mono- 
graph, the information for which had been pains- 
takingly gathered from replies to two hundred 
circulars which he had issued to medical men all 
over America, somewhat after the manner of 
Phoebus ; although, unlike Phoebus, Beard had 
himself seen and treated many cases. From his 
data he drew the conclusion that the immediate 
exciting causes were more than thirty in number, 
and that secondary causes might increase this list to 
more than one hundred. He also showed from his 
statistics that the nervous temperament existed in 
a great proportion of the sufferers, and that nerve 
tonics were of some value. In 1877 Marsh, of 
Tuckerton, New Jersey, published an essay in 
which he accepted completely the pollen theory. 



26 HAY-FEVER. 

He first called attention, in this paper, to the 
activity of the pollen of Ambrosia artcmisicefolia y 
or common ragweed, as by far the most active 
of the pollens in America in producing the 
attacks. 

In 1882 Daly, of Pittsburg, first called atten- 
tion to the fact that a diseased condition of the 
nasal cavities was an important factor in the pro- 
duction of the exacerbations of the disease. Roe, 
of Rochester, in 1883, advocated the same theory, 
but added that " removal of the diseased tissue 
removes susceptibility to future attacks." In the 
same year, Sajous' essay appeared in which he 
advanced idiosyncrasy as a heretofore unconsid- 
ered element in the cause of hay-fever, and laid 
stress upon the three essential factors in the pro- 
duction of an attack; viz., first, an external irritant, 
second, a predisposition of the system, and, third, 
a vulnerable or sensitive area. In 1883 Hack 
accepted the local theory of the causation of the 
disease. In 1884 Harrison Allen, of Philadelphia, 
attributed the affection to a permanent or tempo- 
rary obstruction of one or both nasal chambers. 
In this year, J. N. Mackenzie, of Baltimore, termed 
the disease " coryza vasomotoria periodica," be- 



HISTORY. 27 

cause it is essentially a coryza. He says: " The 
well-recognized, but imperfectly understood per- 
sonal susceptibility to certain forms of local irri- 
tation, which is the sad prerogative of sufferers 
from this disease, has always been the stumbling 
block in its investigation and the rock upon which 
the various speculations as to its nature have been 
wrecked." He demonstrated that " there exists 
in the nose a well-defined sensitive area whose 
stimulation through a pathologic process or 
through ab extra irritation is capable of producing 
an excitation which finds its expression in a reflex 
act or in a series of reflected phenomena." He 
thus claimed functional derangement of nerve cen- 
ters as essential to the disease. It was also in 1884 
that Sir Morell Mackenzie asserted that the uni- 
versal cause of the disease was pollen, although he 
did not deny that other irritating particles, e. g. y 
ipecac, if persistently brought in contact with the 
mucous membrane of the nasal chambers, may 
produce it. 

In 1885 Seth S. Bishop advocated the uric acid 
theory of the origin of the disease. 

In 1887 Sir Andrew Clark, in the Cavendish 
Lecture in London, emphasized the doctrine of 



28 HAY-FEVER. 

the three great causative factors, — viz., first an 
exciting agent, generally pollen ; second, the neu- 
rotic habit ; and, third, a local morbid condition of 
the nasal mucous membrane. 

Since then many articles have appeared upon 
the subject, but no striking innovations in the 
possible etiology of hay-fever have been offered. 

In 1893 Macdonald said, we ought not to 
describe hay-fever as a disease but merely as a 
train of symptoms — a train of physiologic reflexes 
instigated by an unwarrantably small provocation 
in certain individuals more susceptible to the influ- 
ence thereof than the rest of their kind. 

Early in 1897 Grayson, of Philadelphia, stated 
that " the neurotic habit may exist but is not 
essential to the disease, and the nervous system 
is implicated as a victim, not as a culprit." He 
claimed that hay-fever is a defect, not of the 
nervous, but of the nutritive system, believing 
that the digestive tract is the cradle of the 
systemic error. 

In October, 1897, Edmund W. Holmes, of 
Philadelphia, stated his belief to be that hay-fever 
was largely a neurosis, originating in local disease 
of the nasopharynx, the characteristic manifesta- 



HISTORY. 29 

tions being in part direct, the result of central 
nervous modifications, and in part reflex, from the 
action of various mechanical irritants, aided by 
local and constitutional factors when they exist, 
and by seasonable and climatic influences, the 
periodic and peripheric susceptibility being in 
particular expressions of certain impressions. 



30 HAY-FEVER. 



EXCITING CAUSES. 

It being generally recognized that there are two 
elements entering into the causation of hay-fever, 
viz., an exciting agent and a predisposing or 
preexisting condition, regard will be given the 
subject of causation from this standpoint. 

A great number of agencies have been re- 
garded as the direct causes of this disease, but 
opinion in the main has assigned pollen as 
the essential factor, acting upon the preexisting 
condition or predisposition. It may be better, 
however, to give a resume of other agencies 
before regarding this subject of pollen. The 
most important of these are heat, light, dust, 
ozone, overexertion, ipecac, lycopodium, cou- 
marin, benzoic acid, chocolate, or several of 
these in combination. 

Heat. — No attempt to signify or designate a 
definite cause was made by the early writers until 
1819, when Bostock first described the malady 
and ventured the view that it was due to the 
influence of solar heat. He attributed his own 



EXCITING CAUSES. 3 I 

prolonged sufferings to the exposure to the sun's 
rays and fatigue. 

Some time after, Phoebus attributed the affection 
to " the first heat of summer," which, he stated, 
"is a stronger cause than all the grass emanations 
put together." Phoebus subsequently modified 
his views so as to regard the first heat of summer 
as acting only in an indirect manner as an exciting 
cause, and admitted that hay and the blossoms 
of rye caused exacerbations. It can not be con- 
tended, at this day, that heat alone will provoke 
the disease. In the plains of India when the heat 
is greatest it is not found, although later in the 
year, in the cooler months and before vegetation 
is burned up, it does appear ; but among the hills 
of India where the climate is milder and the 
grasses and cereals are in blossom hay-fever 
exists. At sea, when vessels are becalmed and 
heat is most intense, and in the great heat of the 
desert hay-fever is not found. Pirrie shows that 
great heat is common to all cases, even when 
the vegetable world is looked to for the cause, and 
strangely points out that the premonitory feelings 
of an attack coincide with those caused by high 
temperature. One of the most interesting cases 



32 HAY FEVER. 

from this standpoint is that of an Englishman, 
who, although not a medical man, is well known 
to science — Richard Proctor. The asthma — for 
it took this form — occurred only during the cold 
months, and was always aggravated by a rime or 
hoar-frost, especially if the latter was followed by 
a bright, sunny day. 

It is a striking fact that in regions compara- 
tively free from the disease persons subject to 
it become worse on warm days, or when the wind 
blows from the South. It has been found by expe- 
rience that while this aggravation by winds is 
in most part due to the presence of more pollen, 
the higher temperature is also in a measure respon- 
sible. Hot, dry days are more favorable to the 
dissemination of pollen than rainy ones, and it 
becomes especially active when hot, dry periods 
follow stormy weather. In the light of Blackley's 
experiments upon the amount of pollen in the 
atmosphere, these facts would seem to explain the 
action of heat and sunlight as an active cause in 
the production of the exacerbations of hay-fever. 

Light. — Phoebus was dissatisfied with the view 
of the influence of solar heat, and thought that 
the longer days, which produce a more continuous 



EXCITING CAUSES. 33 

action of light, were perhaps to blame; but where 
light is strongest and lasts the longest — indeed, in 
the land of the " midnight sun " — hay-fever is 
practically unknown. Pirrie called attention to 
the fact that exposure to strong light aggravated 
the symptoms of the attack. The foregoing case 
of Richard Proctor is an instance of the truth of 
this. There is an instance of the widow of a cler- 
gyman whose attacks, most severe in summer, 
were aroused by sunlight in the early morning. 
Ingals knew a clergyman who was unable to cross 
the street on a hot day without sneezing violently 
unless he carried an umbrella. Persons with sen- 
sitive mucous membranes, especially subjects of 
hay-fever, are, no doubt, sometimes liable to at- 
tacks of sneezing from sunlight ; but these symp- 
toms must not be mistaken for true hay-fever. 
Ingals states that he knew an individual in whom 
attacks of sneezing were brought on by exposure 
to bright gaslight. Gaslight was also regarded by 
Beard as a cause of this affection. However, 
Morell Mackenzie shows that gaslight is employed 
more in winter when the affection does not prevail 
than in the English spring and American autumn, 
when the affection most prevails. Nothing can 
3 



34 HAY-FEVER. 

exceed the reflected glare of sunlight at sea on a 
bright day, yet it is upon the sea that exemption 
from attacks of hay-fever is universally found. 

Dust. — From his scientific investigations upon 
the subject, Beard, whose published work is a 
model, concluded that it was extremely probable 
that dust occasionally caused hay-fever. Out of 
198 cases of hay-fever reported by him no less 
than 104 attributed the affection to dust. One 
hundred and forty-two of these cases, however, 
occurred between May and September, the usual 
hay-fever season ; and the lay, not the trained 
professional, mind advanced the causes. Some 
attributed the affection to " indoor dust "; some to 
"cinders." These data of Beard, therefore, must 
be taken cum grano salts. More especially is this 
so since a paroxysm of sneezing and subsequent 
coryza, frequently brought on in normal health by 
the mechanical irritation of dust or even strong 
odors, should hardly be dignified as an attack of 
hay-fever. In England, in February, March, and 
April, when strong east winds often blow clouds 
of dust against the face, the symptoms of hay- 
fever do not appear, whereas in June and July, 



EXCITING CAUSES. 35 

when dust is comparatively little, the affliction is 
most extant. 

Holmes stated that even in winter-time stirring 
among old books or in an old garret the exposure 
to the fine dust therefrom would, by simple me- 
chanical irritation, produce an attack in him. It 
has been the consideration that dust, or pollen act- 
ing as any other form of dust, could be kept from 
entering the nasal chambers that has given rise to 
the various inventions to purify the air before it 
enters the nose, such as plugs of cotton or wool, 
and veils (which, in addition, soften the glare of 
the sun and lessen the irritating action of winds 
upon the face). Every hay-fever sufferer knows 
the little value of such device. 

Ozone, Benzoic Acid, etc. — From the vast 
quantity of facts and observations gathered to- 
gether by him, Phoebus, who previously had 
ascribed sunlight as the cause of hay-fever, en- 
deavored to extract a complete theory of the 
disease. He suggested an excess of ozone in the 
atmosphere as a possible cause. It remained, 
however, for Blackley, in 1873, by his great 
endeavors and scientific methods of investigation, 
to disclose the fallacy of this theory. He pur- 



36 HAY-FEVER. 

posely breathed air highly charged with ozone 
for five or six hours without effect ; and without 
inconvenience he inhaled ozone artificially pre- 
pared and in quantities far exceeding that found 
in the same volume of atmospheric air. This 
same physician also studied upon himself the 
effects of benzoic acid, a substance shown by 
Vogel to be contained in Anthoxanthum odoratum 
and Holcns odoratus, the two species of flowering 
grasses to which the causation of hay-fever has 
been attributed. Likewise he investigated the 
odorous principle of many flowering grasses, cou- 
marin, and the volatile oils which impart to many 
plants, such as peppermint, juniper, rosemary, and 
lavender, their characteristic perfume. In all these 
cases the results were negative. 

Various Other Exciting Causes. — These are 
in numberless variety and many of purely idiosyn- 
cratic nature. Emanations from dry hay, sun- 
light, gaslight, heat, minute organisms as supposed 
by Helmholtz, the " mange " insect, dusts of all 
kinds, bad air, railway smoke, brimstone matches, 
flowers and fruits, odors from dogs, cats, horses, 
cattle, rabbits, guinea-pigs, and wild animals, have 
all been held responsible for the paroxysms. 



EXCITING CAUSES. 37 

Ward Smith records linseed meal and mustard 
as exciting causes. Win. Murrell mentions pow- 
dered May-apple (podophyllum), the effluvia of 
clean pocket handkerchiefs fresh from an ironing 
table, locust-tree blossoms, mulberry blossoms, 
and fruit. The exhalations from feathers have 
been regarded as causes. It is well-known that 
various drugs like ipecacuanha and lycopodium 
give rise to attacks, and sulphur has been men- 
tioned as a cause. Sir Thomas Watson names a 
servant in St. Bartholomew's Hospital affected by 
ipecac. Cullen tells of an apothecary's wife who, 
whenever ipecac was triturated in the shop, had an 
attack of hay-fever. He also mentions the vicinity 
of a rice-threshing floor as a provocative cause. 
Itzigson tells of a merchant who had hay-fever 
paroxysms whenever fresh coffee was handled in 
his presence ; and it is recorded of a dyer that he 
could not work when the wood of the oak (Quercus 
tinctorid) was lying about. The author knows of a 
case in a physician in whom violent paroxysms of 
sneezing are induced by the tasting of chocolate. 
It is related in the " Twentieth Century Practice 
of Medicine " that a hay-fever patient fond of 
tomatoes and watermelons was unable to eat 



38 HAY-FEVER. 

of them during the usual hay-fever season without 
most violent disturbance of the gastro-intestinal 
tract. Bastian was subject to attacks of an affec- 
tion like hay-fever while dissecting the Ascaris 
megalocephala, a parasite infecting the horse. 
Hyde Salter tells of a clergyman affected by the 
vicinity to a dead hare, and who was thus able to 
detect the presence of a poacher. H. Charlton 
Bastian had like effects from the " mange " insect 
of the horse. Ringer and Murrell tell of a young 
gentleman made worse by the vicinity of horses 
or stable people. Once, while in the theater, an 
attack suddenly supervened without any appreci- 
able reason until a horse galloped upon the stage. 
Macdonald, in 1893, mentioned a patient who, two 
or three hours after having patted his horse with 
his gloved hand, inadvertently put it to his face, 
and was immediately seized with a violent par- 
oxysm. The odor from the inner aspects of 
the legs of the horse was very irritating to one 
writer a " sufferer." Ringer and Murrell cite the 
case of a gentleman who, subsequent to an acute 
pleurisy, was ever after a subject of " hair-cater- 
pillar asthma," and was immediately attacked if by 
any chance he touched a caterpillar. 



EXCITING CAUSES. 39 

The difficulty of sometimes finding some excit- 
ing agent is shown by the case of Drenger. After 
searching several years in vain for the cause of 
attacks of hay-fever caused by entry into a certain 
room in a house, and after ransacking nearly 
everything in the house, a mattress was sus- 
pected, and, upon removal, was satisfactorily shown 
to be the offending agent. 

The odor of peaches, of violets, of the mign- 
onette, of chocolate, of musk, and of pepper- 
mint, has come in for a share of the blame. 
Trosseau relates of himself that attacks came on 
when he entered a room in which there were 
violets. The botanist Broussais was often im- 
peded in his work by attacks caused apparently 
by the odor of a rose. Hunerswolff and Morell 
Mackenzie each cite a case in which the perfume 
of the rose produced attacks of coryza. The 
former's account is in the " Ephemerides," and 
has been often referred to. The latter's case 
proved rebellious to treatment, and the sufferer 
had, at last, to banish these flowers from her gar- 
den. That this peculiar antipathy to flowers is 
often imaginative is shown by John N. Mackenzie, 
who cites the case of a subject of hay-fever to 



4<D HAY-FEVER. 

whom he handed an artificial rose. Immediately 
an attack of rose-cold ensued. A patient men- 
tioned by Morell Mackenzie, while gazing upon a 
picture of a hay field, was seized with an attack of 
hay-fever. These last two instances indicate the 
psychic influence rather than any extraneous 
cause, but they serve to show the varieties of 
exciting agents. 

The Pollen Theory. — The external cause 
which has been by far the most generally recog- 
nized and accepted as the most frequent is 
pollen. The older writers upon this theory did 
not distinguish the underlying condition necessary 
before pollen could act as a cause of the disease. 
The remarkable and elaborate experiments of 
Blackley, from 1866 to 1878, conclusively prove 
that a most important exciting cause of hay-fever 
is found in the action of pollen upon the mucous 
membrane of the nasal cavities. In his own per- 
son he showed that the inhalation of pollen 
always brought on the symptoms of hay-fever; 
that there was a direct relation between the in- 
tensity of the symptoms and the amount of pollen 
in the air, and that none of the other agents re- 
ferred to, such as heat, light, ozone, dust, or odors, 



EXCITING CAUSES. 4 1 

would, of themselves, cause the distress. His 
range of observation included the pollens of 
various grasses and of cereals and of plants of 
thirty-five other natural orders. His experiments 
were made in the hay-fever season in England, 
between the end of May and the latter part of 
July, and showed that ninety-five per cent, of the 
pollen contained in the atmosphere belonged to 
the Graminacece. The apparatus from which he 
obtained the most satisfactory results in his inves- 
tigations consisted of a vertical plate of glass, 
Y% of an inch in diameter. It was covered with 
a hood, and was pivoted to an upright staff. A 
weather-vane surmounted the hood to control the 
face of the glass-plate before the wind. Upon this 
glass-plate was affixed a microscope cover-glass, 
one cm. in diameter, covered with glycerin. Any 
pollen floating in the atmosphere would thus be 
carried upon the plate by the wind-current and 
adhere to the glycerin upon the glass-slide. 
Blackley thus found that the amount of pollen 
caught upon the plate increased progressively 
from the seventh to the thirtieth of May, when 
twenty-five grains were counted, to seventy-six 
grains on the eighth of June, and to 280 grains on 



42 HAY-FEVER. 

the tenth of June. On the twenty-eighth of June 
880 grains were counted, after which date they 
decreased until the first of August, when they had 
completely disappeared. Bright, sunny days 
brought large quantities of pollen, while rainy 
days decreased the amount. Passing showers 
ameliorated the individual symptoms, though not 
affecting the amount of pollen deposited upon the 
slide. Blackley also clearly showed that the 
mucous membranes of the nasal fossae were not 
affected by pollen in the atmosphere when twenty- 
five grains per diem only were deposited on his 
glass, while seventy-five grains in twenty-four 
hours would irritate in certain individuals. When 
280 grains of pollen per day were deposited 
the direct action upon the mucous membrane of 
this quantity would result in complete vascular 
dilatation. 

Clinical observation has shown a parallel, but 
by no means a complete, analogy to the above 
phenomena in the action of cocain in different 
strengths of solution. 

Emanations from the rose and from rye have 
been shown to have caused coryza, occlusion of 
the nostrils, and sneezing for from six to eight 



EXCITING CAUSES. 43 

hours. The sweet-scented vernal grass (Anthox- 
anthum odoratimi), sweet-scented soft grass (Holcus 
odoratus), meadow grass, meadow fox-tail, Indian 
corn, barley, wheat, oats, bean -flowers, lilies, elder 
trees in bloom, the golden-rod, hay, timothy, and 
clover, and others maybe mentioned. In America 
the pollen of the Roman wormwood, rag-weed, 
or hog-weed {Ambrosia arte misicef olid), is the most 
commonly referred to. It is very common in 
nearly all the States. It blossoms in August and 
September, the prevalent time of hay-fever. 
Wyman and his son, who had fled to the White 
Mountains to avoid hay-fever, were immediately 
attacked when a package of the rag-weed was 
opened there. The seashore, usually exempt, 
sometimes is not so, probably due to the presence 
there of the pollen of the Artemisia gallica, another 
kind of wormwood. In England the Anthoxan- 
tluim odoratum, or " sweet-scented vernal grass," 
seems especially causative. There must also be 
mentioned the common daisy {Bellis perennis) of 
England; also the rye- grass (Lolium percnne) and 
" sweet-scented soft grass " {Holcus odoratus). In 
Germany the rye-blossom is chiefly indicated as 
a cause. In Australia the Cape Weed pollen is 



44 HAY-FEVER. 

regarded as most commonly provocative. It 
covers the hills round about Adelaide to the 
height of some thousand feet or so. Most of the 
population of Adelaide are affected with hay-fever 
during the time of its blossoming, viz., in Septem- 
ber. In India, where the malady occurs chiefly in 
February, it is the blossoms of the mango-tree 
{Mangifera indie a) that are held responsible. 

J. C. Wilson holds that most subjects are not 
sensitive to emanations from hay, and points out 
that there are no distinctive bacteria to give rise to 
the affection. Marsh, himself a sufferer, stated his 
belief in the pollen theory, conceiving hay-fever 
analogous to Rhus toxicodendron, or ivy-poisoning 
of the skin. 

There are two authentic cases which would 
impair the pollen theory, the well-known exemp- 
tion of hay-fever subjects at sea being granted. 
One is mentioned by Walshe,.in which a passenger 
retained his symptoms of hay-fever during a pas- 
sage across the Atlantic. Abbots Smith has 
reported the other, in which the disease came on 
at sea nine miles from land. In this latter case, 
unfurling the sails in which a large quantity of 
pollen had been folded may explain the occur- 



EXCITING CAUSES. 45 

rence. In the former instance the diagnosis was 
by no means certain and the presence of some 
other irritant may have accounted for the distress. 
Moreover, it is by no means impossible for pollen 
to be deposited on a ship even when miles away 
from land. In speaking of the distribution of 
pollen Darwin tells of how the ground near St. 
Louis, in Missouri, has been so widely covered 
with pollen that it looked as if it had been 
sprinkled with sulphur. Pine forests, 400 miles 
south, were probably the place and distance from 
which it came. On March 16, 1883, in Philadel- 
phia, ignorant people took for brimstone a 
shower of yellow pollen which had been blown 
from some distant pine forest. 

After citing many of the various causative pol- 
lens Holmes says that he is " not aware that any 
specialized action has been proved; all act (if at 
all) by mechanical irritation." He also shows the 
punctuality of flowering on the self-same date 
yearly is an absurdity, depending, as the flowers 
do, upon the variations of the seasons. The date 
of the flowering of plants varies within certain 
limits, and he points out the mutability of the 
blossoming date, or, more rationally, its limited 



46 HAY-FEVER. 

variation, and further adds that " even as a mere 
irritant, as pollen affects comparatively few, it must 
act upon a condition which is preexistent, which is, 
therefore, independent of and predominates it, else 
would the cause, pollen, produce it universally." 

As already mentioned, it has been claimed that 
a toxin generated from pollen by a fermentative 
process in an alkaline solution is the cause of hay- 
fever. 



PREDISPOSING CAUSES. 47 



PREDISPOSING CAUSES. 

While millions of people are exposed to the 
exciting causes of hay-fever, comparatively few 
suffer from it, and that there is an underlying 
condition, predisposition, or idiosyncrasy, can 
hardly be doubted. Exactly what this is, or on 
what it depends, is unknown. Abbotts Smith 
as early as 1865 spoke of a predisposition to at- 
tacks of hay-fever as one of the principal causes 
thereof. As Holmes has shown, there must be 
individual predisposition, since the exciting causes, 
if pollens, are everywhere. This predisposition or 
idiosyncrasy has generally suddenly developed 
without apparent reason. It has been argued that 
it is systematic or central, and that it is due to 
some local abnormality of the mucous membrane, 
the capillaries, or the periphery of nerves. Once 
acquired, however, it is seldom lost, and it appa- 
rently increases with each successive year. 

Race. — The influence of race is seen in the fact 
that the English-speaking people are the principal 
sufferers. In India, Africa, and Australia it is 
mostly the English and Americans who are 



48 HAY-FEVER. 

attacked. In America it occurs in nearly every 
State, although much more infrequently in the 
South. In Canada hay-fever is rare, especially in 
the maritime provinces. Wyman relates a case — 
the only one reported — of hay-fever in an Indian 
child. Beard mentions that Dr. Jacobi, of New 
York, who practised much among the Germans, 
had never met with a case in that nationality ; and 
in the same city a similar observation was re- 
corded by Dr. Chaveau, a practitioner among 
the French. Sajous has called attention to a 
curious fact in this connection — viz., that the 
principal sufferers, American and English, are 
the only great tea-drinking nations, and that 
this beverage may exert a depressing influence 
on nerve centers. It would be interesting to 
have some information as to the existence of 
hay-fever in China and Japan, the tea-producing 
countries. John N. Mackenzie, in 1884, gives 
the first recorded instance of hay-fever in a 
negro, a male of thirty-five, tall, well-propor- 
tioned, and respectable, the attack lasting from 
the second week in August to late in Septem- 
ber. A sensitive spot was found on the left 
inferior turbinated bone, i}{ inches within the 



PREDISPOSING CAUSES. 49 

nostril, which gave origin to a most intense 
paroxysm of asthma on simple contact with the 
probe. 

Geographic Distribution. — Reports of hay- 
fever have come from nearly every quarter of the 
civilized globe. It is seldom seen in the far North, 
and is more frequent in the temperate than in the 
torrid zone. It is seen more often in urban than in 
rural districts. The disease is by far the most fre- 
quent in Great Britain and the United States. In 
Norway, Sweden, and Denmark it is seldom found, 
and it is scarcely ever seen among the natives of 
Russia, Germany, France, Italy, or Spain. The 
English and Americans in India and Africa are 
the only ones who are affected by it. Macdonald, 
in 1893, said the Irish are certainly not exempt. 
In the north- of Scotland it is very infrequent, while 
in the south of England the disease is more fre- 
quently found than in the north. In Australia 
and New Zealand it is occasionally found. Litera- 
ture is strangely silent about South America, but 
this land is strange to us in many other ways. 
Pirrie gives an instance of an English officer in 
India suffering there when vegetation was alto- 
gether different from the forms met with in Eng- 
4 



5<D HAY-FEVER. 

land where his attacks had begun. The complaint 
has made its appearance in two instances when its 
victims were at sea ; one, reported by Abbotts 
Smith, after shaking out the sails when nine miles 
out at sea; and another, reported by Walshe, in 
which the patient suffered throughout a voyage 
across the Atlantic. A " sufferer " records that 
numerous portions of England, especially the 
highlands and the sea-coast, and nearly all of 
Wales and Scotland are exempt from the disease. 
He also regards the upper side of the St. Lawrence 
River, most of the province of Ontario north of 
the Welland Canal to the Detroit River similarly 
exempt, and he states that the disease is wholly 
unknown to regions above the outlet to Lake 
Huron. 

Wyman has considered the regions of America 
where hay-fever is especially prevalent. That 
portion of the country east of the Mississippi 
River and lying between the 35th and 45th 
parallels of latitude he regarded as the territory 
of prevalence. . Canada and the Adirondack 
Mountains, the Appalachian range, and the ele- 
vated plateau throughout New York State he 
considered almost exempt from hay-fever. That 



PREDISPOSING CAUSES. 5 I 

portion of the United States west of the Missis- 
sippi River he seemed to think, as did Beard 
also in his later investigations, was free from the 
disease. Beard based his reasons upon the lack 
of vegetation and the sparseness of the popula- 
tion. Bosworth regards as better reasons the 
rugged mode of life of the inhabitants and the 
consequent vigorous health of the frontier life. 
It is a curious observation, too, that certain por- 
tions of the White Mountains country, formerly 
regarded as invariably free from hay-fever, of late 
years, probably owing to the extension of civili- 
zation and its vegetation to these regions, are 
no longer exempt from it. Southern climates, to 
a certain extent, are exempt from the disease. 
Wyman thought it did not- prevail south of the 
35th parallel of latitude, with the exception of 
certain districts in the neighborhood of Milledge- 
ville, Georgia, Montgomery, Alabama, and Beau- 
fort, North Carolina. There can be little doubt 
that the affection is less common in Maryland 
Virginia, in the border States, and in the far West; 
that it is rare in the extreme South and on the 
Pacific slope. The zone between the 35th and 
45th parallels of latitude practically includes the 



52 HAY-FEVER. 

hay-fever district. Even in this section, local- 
ities, from their proximities to large bodies of 
water or to oceans, to elevation or to absence of 
certain vegetation, afford immunity. A " suf- 
ferer " states that on Lake Michigan hay-fever is 
absent above Ludington, while on the Mississippi, 
in Wisconsin, it is present as far north as the 
Chippewa River, and in some seasons, in a mild 
form, it is seen in St. Paul, Minnesota. It is 
known to extend to the latitude of Memphis in 
the West, Knoxville centrally, and Cape Henry 
on the Atlantic. In 1896 W. W. Bulette stated, 
that in certain sections of Colorado there is a 
variety of the affection known among laymen as 
blossom or cotton-wood fever, and very prevalent 
in regions where the cotton-wood tree abounds. 
The symptoms are practically identical with those 
of the autumnal variety of hay-fever, except that 
the throat and bronchial irritations are intensified, 
and the course of the attack is somewhat shorter. 
Symptoms occur about the twelfth of April and 
terminate in the latter part of May, and rarely last 
longer than July 1st. 

Heredity. — Beard's pamphlet was the first to 
show a radical departure from the pollen theory 



PREDISPOSING CAUSES. 53 

and to establish that the neurotic habit was an 
essential factor. He showed that subjects of hay- 
fever often acquired the affection or the tendency 
to it through inheritance. The facts sustaining this 
view are of " a most overwhelming character." 
Wyman, himself a sufferer, records numerous 
cases in his own family through four generations. 
He proved the powerful influence of heredity in 
many of his cases. It even appears in child- 
hood, he states, and quite generally in those of 
nervous diathesis. In Dr. Morell's family there 
were six sufferers from hay-fever besides himself. 
In the family of Henry Ward Beecher there w r ere 
two besides himself; and Chief Justice Shaw's 
family contained seven. Bosworth says that 
eighteen of eighty cases disclosed direct heredity, 
while in thirty-nine there was either hay-fever 
or asthma in the family. Of the forty cases of 
Sajous', thirty-five per cent, had near relatives 
who presented clear histories of hay-fever, and 
forty-two per cent, had asthmatic relatives, while 
fifty-three per cent, of these cases presented a 
family history of either hay-fever or asthma. 
Morell Mackenzie has several times treated father 
and children for hay-fever at the same time. 



54 HAY-FEVER. 

Prince relates that five members of the same 
family were hay-fever subjects. One daughter of 
thirty years suffered with June cold ever since she 
was five years of age, every year save 1887, 1888, 
and 1889. Her grandmother, mother, and two 
brothers suffered alike. The daughter, convinced 
that mental or nervous influence affected her, in 
1887, was treated by the " mind cure," and for 
three years subsequently was free from her 
symptoms. When the original mind curist was 
dead, in the fourth year, the symptoms returned 
as badly as ever. A " Christian scientist's " in- 
fluence was tried in vain. 

Sex. — There can be little doubt that males are 
more afflicted than females. Of the early forms 
of the disease, however, females seem more sus- 
ceptible than males. Of 433 cases cited by 
Phoebus, Wyman, and Beard, only 142, about 
one-third, were females. Of 506 cases gathered 
from several authors, 342 were males, 164 females. 
Morell Mackenzie met with 38 cases in males and 
23 in females. Men are the more exposed to the 
exciting causes such as dust, heat, pollen, etc., 
although females are the more neurotic. The pro- 
portion is about one female to three males. 



PREDISPOSING CAUSES. 55 

Age. — Only to some extent can age be said to 
affect the disorder. The liability to hay-fever in 
the great majority of cases appears before the age 
of forty. The malady has been reported, how- 
ever, as occurring for the first time in persons as 
old as sixty, and persons of seventy and upward 
have suffered. Of the cases of children who have 
been attacked the disease had manifested itself in 
the parents. It would have probably been re- 
garded as a common cold, had not the parents 
been the subjects of the affection. 

Education. — Most all writers on this subject 
have observed that the disease attacks the better 
educated classes and those of fair social position. 
It is rarely met with among the laboring classes. 
This would seem to emphasize the view that the 
disease is essentially a neurosis. From the notes 
of sixty-one cases of hay-fever in private practice, 
and the sight of many others of which no record 
was kept, Morell Mackenzie found all the patients 
persons of some education, and recalled having 
seen none among his hospital patients. Of forty- 
eight cases of Blackley, all were educated, and 
Wyman made the same observation. Holmes has 
shown that the ignorant classes are not so likely 



56 HAY-FEVER. 

to recognize the disease as a distinct affection, and 
apply for medical aid. 

Occupation and Mode of Life. — The fact that 
the rustic is much less subject to this disease than 
the dweller in the city and town, shows the in- 
fluence of the mode of life. Farmers and agri- 
culturists, exposed, it would seem, far more to the 
exciting causes than others, are peculiarly less 
liable to suffer from it. Beard reports only seven 
such cases among 200. Morell Mackenzie states 
that it is impossible to tell whether the villager 
owes his exemption to the maintenance of vigorous 
health by an outdoor life, or to habitual exposure 
to the cause of the complaint. 

Holmes admirably points out that "a part of the 
mysterious origin must be set down to the indiffer- 
ence of the sufferers who, from year to year, have 
forgotten their periodical affection and failed to 
consult physicians." He says : " Of similar cause 
is the groundwork of the assertion that it affects 
only the wealthy. This is simply because with this 
class there is a higher intelligence and closer at- 
tention to ailments, and the fact that having once 
discerned the actual condition, they, in many in- 
stances, take professional advice or go to a place 



PKKDISPOSING CAUSES. 57 

of refuge, thus drawing notice to themselves, all 
of which things are denied to the lower (poorer) 
classes. It is said that there are some 200,000 
sufferers in the United States, at least within the 
range of observation of the Hay-Fever Associa- 
tion, which, meeting annually at Bethlehem, N. H., 
may be held to represent the more stable and well- 
to-do. From my own experience and observation 
I am convinced that there are many of our working 
people who suffer from this affection who do not 
even recognize the disease." Merchants, profes- 
sional men, persons of sedentary habits and brain 
workers supply most of the victims. The disease 
is not so uncommon among hospital outpatients 
here and in England as formerly. 

The Neurotic Theory. — Concerning the influ- 
ence of the neurotic tendency, Beard pointed out, 
in 1876, two popular misconceptions of the ner- 
ous theory, first, that nervous susceptibility implies 
debility and emaciation, whereas the nervous tem- 
perament is consistent with great strength and 
power of endurance, especially when combined 
with the bilious and sanguine temperaments; and, 
second, that the nervous theory dispenses entirely 
with the influence of exciting causes, as heat, 



58 HAY-FEVER. 

pollen, etc. Beard concluded that the disease is a 
complex resultant of a nervous system especially 
sensitive in this direction and acted upon by the 
enervating influence of heat and by any one or 
several of a large number of vegetable and other 
irritants, and this view has the advantage over 
other theories in that it accounts for all the phe- 
nomena exhibited by the disease in this or in any 
other country. He believed that the transmissi- 
bility of the disease from parents to children ; the 
temperaments of the subjects; the capricious inter- 
change of the early, the middle, and the later 
forms ; the periodicity and persistence of the 
attacks and their paroxysmal character; the 
points of resemblance between the symptoms 
and those of ordinary asthma; the strange 
idiosyncrasies of different individuals in rela- 
tion to the different irritants ; the fact that 
it is a modern disease peculiar to civilization; 
the fact that it most abounds where functional 
nervous disorders are most frequent and is ap- 
parently on the increase pari passu with other 
nervous diseases; and, finally, the fact that it is 
best relieved by those remedies which act on the 
nervous system, — all these otherwise opposing 



PREDISPOSING CAUSES. 59 

and inconsistent phenomena are by this hypo- 
thesis fully harmonized. Prince remarks that 
although a nervous origin has been recognized by 
some, still no theory has been proposed to show 
the connection between the physical symptoms 
and the nervous processes nor the pathology of 
the nervous processes themselves. 

Vasomotor susceptibility has been viewed as 
indicating the neurotic tendency, and this may or 
may not be due to a central lesion. John N. 
Mackenzie regarded disordered functional activity 
of the nerve-centers as the expression of the ner- 
vous origin. Again, a general neurosis disposing 
to vasomotor disturbance of the sympathetic and 
the trigeminus nerves has been held responsible. 
Kinnear speaks of two forms, — one a hyperemia, 
and the other an anemia of the sympathetic gan- 
glion. Bosworth is inclined to think a peculiar 
lack of vasomotor control characterizes the neu- 
rotic manifestations. In asthma there is un- 
doubted vasomotor paresis of the blood-vessels of 
the bronchial mucous membranes, while in hay- 
fever it is of the nasal mucous membranes. 

Solis-Cohen regards hay-fever as generally a 
neurosis, primarily a vasomotor ataxia or idiosyn- 



60 HAY-FEVER. 

crasy. Another view is that it may be due to an 
organic alteration of the nerve-fibers terminating 
in the nasal region and chiefly in three reflex 
areas. Again, that it may be due to functional 
activity or paresis of the governing (vasomotor) 
centers, accompanied by hyperexcitability of the 
erectile (cavernous) tissues aroused by peripheral 
irritation. The phenomena of the cavernous nasal 
tissue, though secohdary to the centric condition, 
indicates a vasomotor disease. Hack and Robin- 
son believe the morbid lesion is one of neurotic 
disposition with hyperesthetic condition of the 
olfactory and fifth pair of cranial nerves. 

Idiosyncrasy. — Analogous to the neurotic habit 
is idiosyncrasy. Apparently the same under- 
standing as to what an idiosyncrasy is has 
underlain the use of this word by various writers 
who have advanced idiosyncrasy as a cause of 
hay-fever. Morell Mackenzie, in 1880, put it 
down as a predisposing cause, but does not say 
upon what the idiosyncrasy depends, whether 
upon some local abnormality, the capillaries, the 
nerve-centers, or the periphery of the nerves. 

In 1897 S. Solis-Cohen said idiosyncrasy is a 
real condition in hay-fever, and cited the idiosyn- 



PREDISPOSING CAUSES. 6 1 

crasies to salicylic acid, quinin, ipecac, opium, etc., 
as similar to idiosyncrasies that patients exhibit 
toward the different irritants capable of producing 
hay-fever. Using the word to express the fact that 
certain persons react differently from most of man- 
kind to certain forms of irritation, it means some- 
thing. It means that such persons are abnormal, 
although the cause of the abnormality remains to 
be discerned. Holmes, speaking of idiosyncrasy, 
would not say there is no such thing as idiosyn- 
crasy, but as far as hay-fever went, he held that 
the disease was an actual one, the nature of which 
was not yet comprehended. He remarks that it 
is quite probable that uric acid would aggravate 
hay-fever as it would any other condition in the 
body ; and that some think to have proved this by 
the use of salicylic acid, to which drug many per- 
sons have an idiosyncrasy, thereby aggravating 
the condition in hay-fever by the elimination of 
uric acid. 

Dr. Samuel Ashhurst, in 1897, recorded his 
habit of regarding hay-fever of late years as a 
personal idiosyncrasy acted upon by some irritant, 
and observed that without this personal element 
it is difficult to account altogether for the symp- 
toms and their peculiar periodicity. 



62 HAY-FEVER. 

Local Disease Theory.— In 1882 Daly ad- 
vanced the theory of the local disease as causative 
of hay-fever, and reported a case in which the 
patient recovered after the removal of a nasal 
polyp, which by continuous mechanical irritation 
had doubtless given rise to the condition under- 
lying. Examinations of the nares of hay-fever 
patients have repeatedly failed to show any local 
disturbance other than general congestions. 
Daly's theory was subsequently accepted and 
supported by Hack and Roe, who both affirmed 
that the influence of a morbid condition of the 
nasal mucous membranes favored the develop- 
ment of hay-fever. In 1883 Sajous and Herzog 
wrote important papers to prove the same facts. 
In the same year J. N. Mackenzie demonstrated 
that " there exists in the nose a well-defined sensi- 
tive area whose stimulation through a local patho- 
logic process, or through an extra irritation, is 
capable of producing an excitation which finds its 
expression in a reflex act or in a series of reflected 
phenomena." He located this area at the posterior 
end of the inferior turbinated bones and corre- 
sponding portion of the septum. It has since 
been held by advocates of the local theory, that 



PREDISPOSING CAUSES. 63 

diseases and abnormalities of the nose, such as 
a markedly deviated septum, outgrowths from the 
septum, hypertrophic rhinitis, enlargement of the 
inferior or middle turbinated bodies, mucous 
polypi, and marked turgescence of cavernous tis- 
sue on the inferior turbinated body, were all pro- 
vocative of hay-fever paroxysms. 

In 1884 Harrison Allen declared that the pri- 
mary lesion was one of obstruction, temporary or 
permanent, in one or both nostrils, from one of 
various causes, attended by vascular dilatation. 
Bosworth likewise held that the existing morbid 
condition of the intranasal tissues must be one of 
an obstructive character, tending to produce in 
itself vascular dilatation. Regarding nasal polypi, 
occasionally considered as active causes of hay- 
fever, Bosworth concludes that they are rather a 
result than a cause, since the great quantity of 
outpoured serum. makes the nasal mucous mem- 
brane sodden or water-soaked, and in this way 
myxomatous degeneration develops, eventually 
assuming the form of polypi. 

J. N. Mackenzie, however, examined the nares 
of many sufferers from hay-fever without finding 
any nasal lesion. Holmes noted an instance most 



64 HAY-FEVER. 

carefully reported, in which, with cold snare and 
galvanocautery, all obstructions w r ere removed, 
and areas rendered anesthetic so that a probe no 
longer excited reflex symptoms, yet the patient 
suffered from hay-fever with scarcely diminished 
intensity. He further observes that at least a de- 
gree of the condition might be the result and not 
the cause, the peripheral susceptibility being an 
outward expression of an inward state. 

In 1885 Thornwaldt, in Wiesbaden, in his ob- 
servations on nasal catarrh, assumed that naso- 
pharyngeal disease might not only give rise to 
symptoms simulating nasal disease, but was likely 
the actively predisposing cause of asthma and hay- 
fever. Bosworth agreed with him as far as hay- 
fever is concerned. 

The Uric- Acid Theory.— In 1893 Seth S. 
Bishop announced to the American Medical Asso- 
ciation that " an excess of uric acid in the blood 
causes hay-fever, or nervous catarrh." Uric acid 
in the blood in marked excess of the normal rela- 
tion to urea, of about one to thirty-three, causes 
certain disturbances of a vascular and neurotic 
character. In health, five to eight grains of uric 
acid are secreted every twenty-four hours. Haig 



PREDISPOSING CAUSES. 65 

claimed that an effect of an excess of uric acid is 
contraction of the arterioles and capillaries all 
over the body. He found that by diminishing the 
alkalinity of the blood it was freed from uric acid, 
the arterioles were relaxed, and the headaches and 
mental depression were relieved. Cerebral anemia 
has appeared to obtain in hay-fever, and the at- 
tacks were relieved, Haig found, by such remedies 
as relieved anemia of the brain, e. g., amyl nitrite, 
coffee, and other cerebral stimulants. These views 
of Haig were concurred in by Thomas J. Mays, 
Murchison, Conklin, Ebstein, Quinquaud, and 
others. Bishop, in 1894, remarked that the blood 
in the morning is more alkaline than at any other 
time of the day, being, at about nine o'clock, at its 
greatest point of alkalinity, which would seem to 
account for those attacks of hay-fever which came 
on early in the morning, and which in some in- 
stances were ascribed to the influence of light. 
He was of the opinion that not only an excess 
of uric acid in the system, but also an in- 
creased formation thereof should be regarded 
in the treatment of hay-fever. Bishop also 
claimed that the uric-acid theory was not antago- 
nistic to the essentially neurotic character of the 
5 



66 HAY-FEVER. 

disease. He also advanced that the primary de- 
termining cause of the particular manifestations in 
this disease is an inherent, perhaps hereditary, 
susceptibility of the nervous system. In this way 
only can we account for the fact that the same 
subjective or objective exciting cause (uric acid or 
pollen) will produce one train of distressing symp- 
toms (nervous coryza) in one individual, and an 
entirely different one in another (asthma). This 
uric-acid hypothesis explains why some persons 
suffer from attacks under certain conditions in 
winter as well as during the warm months. It also 
unifies all the forms. 

Bishop says : " The uric-acid theory of hay- 
fever is not antagonistic to the present status of 
medical opinion or surgical treatment, but, on 
the contrary, it explains questions that were 
inexplicable before. As a tumor or hypertrophied 
bone may give rise to convulsive seizures in 
epilepsy, and as its removal may be followed by 
relief when no other structural cause exists, so in 
hay-fever, when new growths and other lesions of 
the nasal mucous membrane are present, the 
attack may be started by the accumulation and 
the sudden setting free of uric acid. This pre- 



PREDISPOSING CAUSES. 67 

cipitates the paroxysm by its irritant action, 
which finds expression in the group of symptoms 
characteristic of hay-fever or asthma, instead of 
some one of the other allied diseases. The 
particular form of manifestation may be deter- 
mined by the growth or the seat of irritation 
located in the nasal cavities. When this is the 
only determining factor of the nature of the 
morbid symptoms, no other disease having re- 
sulted from the long-standing trouble, the removal 
of such a peripheral source of irritation may give 
relief from these symptoms, but it may not 
prevent the uricacidemia from switching off into 
other kindred lines of disturbances, if it be not 
corrected. " 

Capp, in advancing a new view, inclines to the 
uric-acid theory, and alludes to a certain spastic 
condition not mentioned by other writers, which, 
although slight in character, is general, rather than 
confined to limited areas, and in a large measure 
accounts for many manifestations of the disease. 
A central nervous irritation is probably caused 
by the presence of a disturbing element in the 
blood, presumably products of imperfect meta- 
bolism not eliminated. This may originate 



68 HAY-FEVER. 

nerve-currents with innumerable reflexes, which, 
in the disturbed equilibrium of the system, are, 
in a measure, uncontrolled by the ordinary 
inhibition. 

Holmes has very cleverly pointed out a fallacy 
in regard to the evidence advanced to substan- 
tiate the uric-acid theory. He states that some 
investigators by the use of salicylic acid and 
various acids to diminish the alkalinity of the 
blood thus eliminating uric acid, have, thereby, 
actually aggravated the condition in hay-fever, 
which aggravation has been thought due to excess 
of uric acid in the tissues, or increase in its pro- 
duction, instead of being due to the idiosyncrasy 
to salicylic acid, etc. 

In 1897 Grayson stated that even if we grant 
that a certain number of hay-fever patients are 
unquestionably people of a neurotic temperament, 
while others are gouty, can not we profitably look 
beneath these titles and recognize the fact that 
they are dyscrasias, which are merely different 
offshoots from a parent weed that is rooted in 
defective nutrition ? By defective nutrition is 
meant all the phenomena of metabolism, — con- 
structive, destructive, and eliminative. Disturb- 



PREDISPOSING CAUSES. 69 

ance of one means disturbance of all. With 
continued absorption of toxic materials from the 
intestinal tube, or with persistent incomplete elimi- 
nation of the products of suboxidation, it is only 
a question of time when autotoxemia will provide 
us with any of the functional neuroses from hay- 
fever and asthma to chorea and epilepsy. 

Grayson says the neurotic habit may exist, but 
it is not essential to the disease, but the nervous 
system is implicated as a victim, not as a culprit. 
He claims that hay-fever is a defect, not of the 
nervous, but of the nutritive system, because im- 
pairment of the digestive and nutritive processes 
is almost invariably the first downward step 
toward a general state of lowered vitality. At 
first gastric, it later involves the whole gastro- 
intestinal tract. He thinks uric acid is almost 
invariably present in excess in hay-fever subjects. 
A child having reflex convulsions due to acute 
indigestion is not a neurotic subject, yet the vaso- 
motor perturbation of the hay-fever patient differs 
from that of the child mainly in point of chronicity. 

Grayson concludes that the three factors which 
make up the etiologic combination of hay-fever 
are : An external irritant, some intranasal abnor- 



70 HAY-FEVER. 

mality, and a constitutional element — " defective 
nutrition." The physician unaided can not restore 
the nose to a state of health. In order to over- 
come the self-indulgence of the patient, regularity 
is recommended in eating, work, and play, while 
indiscretions of diet, lack of exercise, objectionable 
fancies in matters of clothing and bathing, and, 
finally, vicious excesses — alcoholic, narcotic, or 
sexual — will require the constant and most de- 
termined effort of the patient himself. The whole 
environment of the patient must be separately 
studied and provided for in the dietary scheme. 
A comment on this treatment is : " While it is true 
that if a man takes care of his muscles his nerves 
will take care of themselves, there is no closing of 
the eyes to the fact that to the average man exer- 
cise is distasteful ; therefore, it is the more neces- 
sary to be explicit in instructions concerning it. 
Though there is nothing brilliant about this 
method of removing the constitutional factor of 
the disease, what it lacks in brilliancy is more than 
made up in certainty, and if the patient is pos- 
sessed of grit and determination it brings a sure 
reward." 

J. Miiller thinks there is a causal relation 



PREDISPOSING CAUSES. 7 I 

between hay-fever and gastro-intestinal symp- 
toms, but he also holds that it can be proved that 
pollen entering the respiratory tract is the cause of 
the disease. A " sufferer," writing on the disease, 
says: " Indigestion is a most potent cause in many 
instances, and proper food, properly digested and 
assimilated, has permanently relieved more than 
one." But he does not say he himself was re- 
lieved, nor does he give cases. 

It is questionable whether or not the digestive 
disturbances are not effects rather than causes of 
the disease. It is not at all doubtful, however, 
that lowered resistance and a depreciated vitality 
may result from difficulty in the gastro-intestinal 
tract. Such difficulty may suffice to start the chain 
of hay-fever symptoms. 



*]2 HAY-FEVER. 



TIME OF OCCURRENCE. 

On the continent of Europe, where it is less 
frequent, and in England hay-fever prevails in 
June and July. The initial attacks occur during 
May and June and seldom last longer than Sep- 
tember. In India the malady chiefly occurs in 
February. In Australia, in and around Adelaide, 
where the disease prevails, it occurs chiefly in 
September during the time of the blossoming of 
the Cape weed. In his work on hay-fever, Beard 
essays to show how the autumnal form is peculiar 
to the United States. One cause seems to be the 
flowering of the Roman wormweed and the pollen 
of corn about the middle of August, and another 
in the prevalence of the " dog-days." A third 
reason lies in the fact that there is less atmospheric 
ozone and electricity at this period than at any 
other time of the year, and, again, the hottest 
days are frequently in the latter part of June. 
Beard also attached importance to a variety of 
hay-fever in which the attacks came on in Sep- 
tember. This distinction is probably due to the 
fact that while one person is liable to the action of 



TIME OF OCCURRENCE. 73 

one pollen, another may be affected by a totally 
different pollen, and the annual attacks come on 
when the atmosphere is permeated by a special 
pollen to which the victim is individually suscep- 
tible. Many persons are susceptible to the action 
of more than one pollen. Patients often suffer 
from rose colds in early summer, and, again, in 
August, from the autumnal form of hay-fever. 
Of the 198 cases collected by Beard the onset of 
the disease occurred — 

From May 1 to May 10, in 2 cases. 
u « IO << u 3Ij << 6 « 

" June I " June 10, " 1 1 " 

« " 10 " " 30, << 8 " 

" July I " July 10, " 6 " 

a a IO a it 20? u 5 a 

a a 20 a a ^1, a y a 

" Aug. 1 " Aug. 10, " 7 " 

a a IQ a a 20? a gj c< 

« « 20 c< « 3I> « ^ << 

" Sept. I " Sept. 10, " 7 " 
" u 10 " M 20, " I case. 
" " 20 " " 30, " 2 cases. 

Of Bosworth's eighty cases the greatest num- 
ber, fifty-one, occurred between August ioth and 
August 27th. The usual date assigned for the 
commencement of paroxysms of hay-fever is the 
29th of August. This form of the disease, com- 



74 HAY-FEVER. 

mencing in the latter part of August, is designated 
as autumnal catarrh. 

Many patients have asserted that they are 
attacked annually on exactly the same date, and 
even the same time of day, each year. There can 
be little doubt that the psychic influence or pecu- 
liar mental anticipation may have a great deal to 
do with this circumstance. An attack may be 
brought on by the influence of the imagination. 
Phoebus gives the history of a case in which 
attacks of sneezing were brought on " while look- 
ing at a beautiful picture of a hay field." The 
well-known instance of J. N. Mackenzie, in which 
an attack of hay-fever was brought on in a suscep- 
tible individual subject to rose cold by means of 
an artificial rose may be explained on this ground. 
Bosworth considers that the time of occurrence is 
influenced by psychic causes, and is analogous to 
the recurrence of chills in intermittent fever, and 
considers that deception as to the actual time of 
occurrence might be proved in hay-fever as in in- 
termittent fever, in which changing the hands of 
the clock may lead to a change in the regular re- 
currence of the chills. Prince gives the history of 
a case in which a hay-fever subject under the influ- 



TIME OF OCCURRENCE. 75 

ence of autosuggestion, by means of writing fre- 
quently on paper and thinking, day and night, in 
leisure moments, and of slight hypnotism, pre- 
vented the premonitory symptoms of hay-fever, 
and she was free from the annual attacks for sev- 
eral years, when they recurred and continued 
yearly thereafter. Prince asks, may it not be that 
the reason why certain places, such as Dublin, for 
instance, are reputed to have a specific influence 
against attacks, is the counter-suggestion thereby 
given that the patient will be free from attacks at 
such places? 



j6 HAY FEVER. 



DURATION. 

Pirrie states that it is next to impossible to defi- 
nitely decide the duration of hay-fever attacks, as 
seasons, age, temperament, locality, treatment, and 
other circumstances tend to cause variations in 
different years and in different individuals. Treat- 
ment will do much to curtail the duration of the 
more prominent and distressing symptoms, but if 
left to themselves it is seldom they depart under 
three or four weeks. A writer in the " Twentieth 
Century Practice of Medicine " estimates the dura- 
tion as from four to six weeks, according to the 
patient's surroundings and the atmospheric condi- 
tions. Asthmatic attacks may last from a few 
hours to three days and disappear suddenly. 
Morell Mackenzie states that attacks last from a 
few hours to several days, or even longer, finally 
ceasing almost as suddenly as they came, and leav- 
ing no trace either in local lesions or in systemic 
disturbance. Bosworth gives eighty cases, show- 
ing the durations of the annual attacks as follows : 

From May I to frost, I case. 

" " 15 " May 25, to July I, . . . 3 cases. 



DURATION. 



77 



From May 10 to Aug. I, I case. 

" June I " July I, 2 cases. 

" " I " " 14, I case. 

" " I " frost, 5 cases. 

" " 10 " July 4, 4 H 

" " 10 " " 26, 5 '• 

" July 1 " Sept. I, I case. 

« « IQ a A ug< If j it 

" " 10 " Sept. 1, 1 " 

11 " 25 " frost, 4 cases. 

44 Aug. 10 " Aug. 27, to frost, ... 51 " 

All forms of hay-fever terminate with the first 
frost, and the long interval in which one may 
suffer is shown by the first case above from May 
1st to cold weather. In the United States some 
who are attacked in May recover by the first of 
July ; some attacked in July are well by the 
15th of August; some attacked in August re- 
cover by November 1st, while some unfortunates 
suffer throughout the period from May to Novem- 
ber. The June type may be followed by a Sep- 
tember visitation or become a permanent August 
attack, or the August type may disappear in cer- 
tain individuals and reappear as a June cold. 



78 HAY-FEVER. 



SYMPTOMS. 

Although the affection is called hay-fever, there 
is seldom any degree of pyrexia, and, as a fever, it 
is not a decided one. There are two well-known 
types of the disease, — the catarrhal and the asth- 
matic. The onset of an attack is occasionally 
marked by feelings of general malaise, a loss of 
appetite, and depression of spirits. Indeed, these 
symptoms more or less characterize the entire 
course of the attack. A " tickling in the roof of 
the mouth " one week before the onset was felt by 
a patient of Sajous. Another speaks of dull pains 
in the head and back two weeks before ; chills and 
shuddering ten days before the attack is experi- 
enced by another, while a large proportion com- 
plain of palpebral pruritus from two to ten days 
before the onset of the nasal symptoms. It is 
only in those subjects whose hay-fever is of some 
years' standing, Sajous points out, that the pre- 
monitory symptoms are present, and gives in 
evidence the testimony of a fellow-physician, viz. : 
" My attacks for some years past came with much 
regularity, about August 12th to August 14th. 



SYMPTOMS. 79 

On these dates this year I arranged to be on the 
water, on Lake Ontario and the St. Lawrence 
River, and entirely escaped everything like sneez- 
ing and irritation of the nose and eyes. Still I 
had the usual hot and slightly irritable skin, then 
an eruption of urticaria, accompanied by dis- 
ordered stomach. This experience is precisely 
the same as in 1880, except that then I was on 
the Atlantic." Macdonald, in 1893, had a patient 
whose earliest symptoms were a curious coldness 
and pallor of the nose even in warm weather. In 
this connection it maybe observed that in 1870 
Roberts conceived the " pathognomonic symptom " 
to be coldness of the tip of the nose. 

Beard divided the symptoms into local and con- 
stitutional. Among the latter he regarded fever, 
loss of strength, the altered appetite and the ner- 
vous system, considering under this last, depres- 
sion, indisposition to labor, sense of fullness and 
heaviness of the head, pain in the forehead and 
behind the ears, partial deafness, restlessness at 
night, inability to sleep, a sense of suffocation, and 
general irritability. For the local phenomena, he 
looked upon the skin, in the heart, chest, mouth 
and nose, eyes and ears. 



80 HAY-FEVER. 

The periodicity of the attacks is a prominent 
symptom and is difficult to explain. Some pecu- 
liar psychic influence occasionally acts to pre- 
cipitate an exacerbation. In no other way can 
we explain the cases of John N. Mackenzie and 
Morell Mackenzie already cited. Analogous to 
this remarkable periodicity are those cases of 
intermittent fever wherein each alternate day, at a 
given hour, the chill occurs. This is generally 
true, moreover, not only of ourselves, but of the 
world around us. As Holmes has beautifully 
shown in this connection, health and disease afford 
abundant illustration : The fixation of the number 
of heart-beats, of the respiratory movements, of 
the cycle of menstruation, or of the period of 
gestation are all recognizable in their unfailing 
occurrence, but their determination thereof, then, 
rather than at some other period, can not be ex- 
plained. So, in disease, are the mutations of the 
enteric temperature, the recurrence of the hectic, 
of the regularity of the return of the types of 
ague upon the second, third, or fourth days, or of 
hay-fever upon its annual date. We must recog- 
nize these phenomena as fixed, further we can not 
go. "As the rhythm of physiologic effects is under 



SYMPTOMS. 8 1 

the control of the central nerve ganglia, and as 
intermittency is a peculiarly marked feature of 
so-called nervous disorders, so far the annual 
return and the variations are evidences of the 
neurotic origin of hay-fever." 

The onset of an attack of hay-fever begins 
with a sense of irritation referred to the upper 
nasal chambers, a sense of fullness or tightness 
across the bridge of the nose. There is an itching 
or burning sensation of the inner canthus of one 
or both eyes, which may be accompanied by con- 
vulsive movements of the eyelid, an itching or 
tingling in the roof of the mouth. Spasmodic 
sneezing soon occurs, and pain in the eyeballs 
and in the frontal regions develops. The parox- 
ysms are more or less violent and prolonged. 
Arnold tells of sneezing in a patient for twenty- 
five times in close succession, forcing the pulse at 
the height of the attack to one hundred and 
twenty beats to the minute. These paroxysms are 
followed by an abundant, thin, serous discharge 
from the nose. The mucous membrane of the 
nasal fossae swells so as to block up the nasal 
passages, and respiration through the nares be- 
comes impossible. The escape of serum from the 
6 



82 HAY-FEVER. 

nostrils seems to increase the intense irritation 
and makes the sneezing worse. The discharge 
from both eyes and nose gradually grows thicker 
and may become semipurulent. There is often a 
certain amount of chemosis, and sometimes pho- 
tophobia, besides the usual pricking and stinging 
of the conjunctival surfaces. There are frequent 
transient paroxysms of lacrimation, and there is 
often much swelling of the eyelids as well as of 
the conjunctivae. The face becomes puffy and 
edematous, and the senses of taste and smell 
become impaired. The pharynx, mouth, and ton- 
sils share in the engorgement and become red, 
and simultaneously the inflammation of the eyes, 
nose, and throat becomes intense and painful. 
Swallowing may become so difficult that there 
is little rest night or day. Insomnia is common 
and is often attended by nervousness and a sense 
of suffocation out of all proportion to the gravity 
of the condition. Cough is not a constant feature, 
but in a considerable proportion of cases it comes 
on in the second week, and lasts through the 
attack. Generally it is spasmodic and so inces- 
sant at night that sleep is impossible, and there 
are soreness and pain resulting from the straining 



SYMPTOMS. 83 

of the diaphragm and intercostal muscles. Bron- 
chitis does not usually result, and expectoration 
is absent or scanty until late. Cough may con- 
tinue after all other symptoms have ceased. The 
pulse and temperature are not generally altered, 
but later in the attack the temperature may be 
raised two or three degrees, doubtless from dis- 
turbed rest. A ft sufferer" records that, in some, 
the genito-urinary and rectal passages give the 
first warning by intense itching and burning. 
In one instance, a more than generally severe 
paroxysm induced rupture of the capillaries in 
the lacrimal caruncle of the right eye, causing 
engorgement of the organ and displacement of 
the visual axis, with consequent double vision 
for some days. The direct and reflex changes 
in the vocal apparatus vary from loss of timber 
and harshness to complete inability to utter nasal 
vowels and consonants. 

The disorder varies much in intensity even in 
the same person within short intervals of time, so 
as to almost give an intermittent character to the 
complaint. 



84 HAY-FEVER. 



COMPLICATIONS AND SEQUELS. 

The attack finally ceases almost as suddenly as 
it came on, leaving no trace of local lesion or 
systemic disturbance. It is accompanied in some 
patients with nettle-rash. Asthma is a late 
symptom, coming on after the acute symptoms 
have abated, and cough has existed for some 
time. It may appear at the height of the at- 
tack. It is more common in autumnal catarrh 
than in the early forms. Its period, as a rule, 
begins at the fourth week, and it does not vary 
from ordinary asthma. It is sometimes periodic, 
occurring at the same hour night after night. 
Paroxysms appear associated with antecedent 
bronchial rather than nasal symptoms. Nasal 
reflex phenomena, without cough, may occasion 
paroxysms. Persistent cough more usually 
exists in the intervals between paroxysms. Beard 
says that four-fifths of the sufferers have cough 
or asthma. The symptoms are not usually of 
equal severity each year. Asthma generally 
comes on in the daytime, a little ropy mucus being 
expectorated, and later, an abundant frothy secre- 



COMPLICATIONS AND SEQUELjE. 85 

tion. There may be only a slight remission, the 
dyspnea continuing so long as exposure con- 
tinues. The attacks rarely produce emphysema 
of the lung, and sooner or later recovery ensues. 
Bosworth estimates that the asthmatic attacks 
come on earlier each year in those who have 
suffered from hay-fever in connection with asthma, 
and he believes that an attack of hay-fever is 
especially liable to develop an attack of bronchial 
asthma as a natural consequence of the disturb- 
ance in the nasal chambers. He also observed a 
number of cases in which hay-fever symptoms 
gradually abated while the asthma became a 
prominent factor, and, again, that victims of hay- 
asthma finally acquired the perennial form of the 
disease, — the attacks occurring at all seasons 
without reference to the presence of pollen in the 
air. 

As already evidenced in Sajous' case, in a 
number of cases the attacks are preceded by 
cutaneous eruptions. Laflaive cites cases with 
urticaria and eczema preceding the onset of hay- 
fever. Facial pruritus and herpetiform eruptions 
are occasionally seen. J. N. Mackenzie speaks 
of an inflammation of the external auditory 



86 HAY-FEVER. 

meatus in all respects analogous to that of the 
nose in hay-fever, occurring repeatedly in a lady 
during the summer months. 

Besides asthma, already mentioned, there is 
little tendency to permanent ill-effects except 
thickening of the nasal mucous membrane from 
the prolonged irritation. Taste and smell may 
be impaired during and for a long time after the 
attack. General irritability and nervousness may 
be more or less persistent. Elderly sufferers 
for a long time may have weakened hearts which 
intermit during attacks, which may recover with 
returning health or result in cardiac dilatation. 
Wyman mentions pneumonia in three cases 
during attacks. In one case the catarrh ceased 
for two weeks to return after the pneumonia 
disappeared, when asthma also came on for the 
first time. 



PATHOLOGY. * 87 



PATHOLOGY. 

Morell Mackenzie states that hay-fever, leaving 
no permanent structural lesion behind it, can not, 
therefore, be strictly said to have any pathology. 
Surely it is that no distinct specific organisms 
have been found. Sajous calls attention to the 
distinct physiologic functions of the two regions 
of the nasal cavities, the olfactory and the respira- 
tory. The filaments of the olfactory nerve cover 
the superior turbinated bones, and the upper third 
of the middle turbinated bones, and the corre- 
sponding portion of the septum. Thus the upper 
portions of the nasal cavities are devoted to the 
sense of smell and do not enter into the pathology 
of hay-fever. The respiratory portion of the nose 
includes all the surfaces below the olfactory. It is 
under the control of the vasomotor nerves of the 
sympathetic system, and is quite sensitive to local 
or peripheral irritation. This sensitiveness resides 
in the terminal filaments of the sensory nerves, dis- 
tributed over the surfaces of the mucous mem- 
branes. The membranes of the posterior areas of 
the nasal fossae are supplied with several branches 



55 HAY-FEVER. 

of the sphenopalatine ganglion, which enter by the 
sphenopalatine foramen. This ganglion possesses 
a sympathetic root derived from the carotid plexus 
through the vidian nerve, thus establishing a con- 
necting link between the nasal mucous membrane 
and the sympathetic system. 

In health the nasal mucous membrane pours out 
from twelve to sixteen ounces of watery serum 
daily, which — that it may warm, moisten, and 
cleanse the inspired air on its passage to the lungs 
— is diffused over the convex surfaces of the turbin- 
ated bones. The centers in the medulla, through 
the vasomotor, control and regulate this process 
of serous exudation; the nicety of which regulation 
is seen in the adjustment thereof to the varying 
hygroscopic and thermic conditions of the atmos- 
phere. 

The experiments of John N. Mackenzie, in 
1884, showed : 

1. That in the nose there exists a w r ell-defined 
sensitive area whose stimulation, through a local 
pathologic process or through an extra irritation, 
is capable of producing an excitation which finds 
its expression in a reflex act, or in a series of re- 
flected phenomena. 



PATHOLOGY. 89 

2. That this sensitive area corresponds, in all 
probability, with that portion of the nasal mucous 
membrane covering the turbinated corpora caver- 
nosa and the most sensitive spots covering the pos- 
terior end of the inferior turbinated body and the 
septum immediately opposite. 

3. That nasal cough is caused only by stimula- 
tion of this area. 

4. That the tendency to evolution of reflex 
phenomena varies in different individuals, and is 
probably dependent upon the varying degree of 
excitability of the erectile tissue. 

These sensitive areas correspond to the distribu- 
tion of the sphenopalatine branches of the superior 
maxillary nerve, as distinguished from the nasal 
branch of the ophthalmic, which latter supplies the 
more anterior portions of the nasal fossae. The 
former nerves, derived through the ganglion of 
Meckel, therefore, probably contain the vaso- 
motor nerves which govern the erection of the tur- 
binated tissue, and, hence, the localization of the 
sensitive areas becomes the key to the mechanism 
of the paroxysms. Nevertheless, Beard was in- 
clined to transfer the point of greatest excitability 
from the peripheral ends of the nerve filaments to 



90 HAY-FEVER. 

the nerve-centers themselves, because it seems a 
more comprehensive explanation of the varied 
phases of the disease. 

Roe explained that the more frequent occur- 
rence of asthmatic paroxysms at night might be 
brought about by the gravitation of blood to, or 
the contact of polypi upon, these sensitive areas. 
Sajous thought it was evident that there were 
three areas capable of producing reflex symptoms 
in the course of a paroxysm of hay -fever, and that 
the three combined formed the key to the local 
nervous element, not that the three areas must 
take part, but in some, one of them, in others, two 
of them, etc. In the asthmatic cases, he noticed 
that both anterior and posterior areas were sensi- 
tive, the latter especially so. 

Capp pointed out two distinct spots or areas of 
the mucous membrane of the nasal cavities, one 
at the posterior and one at the anterior extremity 
of the inferior turbinates, one or both of which 
may be supersensitive in individual cases; also a 
spot in the anterior nasal chambers at the upper 
angle formed by the septum. All these are ex- 
quisitely sensitive, and, when irritated, produce 
extensive reflex symptoms. Trouble appears to 



PATHOLOGY. 9 1 

begin at one or all of the points, while the rest of 
the Schneiderian membrane is in normal condition ; 
but with sneezing, hyperemia and hyperesthesia 
ensue, and, through continuity, may extend to 
throat, ears, and eyes. 

In speaking of the three reflex areas, Holmes 
said that it is regarded that all points of the cav- 
ernous tissue are not equally susceptible to irrita- 
tion ; the sensitive areas are the inferior turbinates 
(the posterior and middle reflex areas) and the 
portion of the septum immediately opposite, being 
particularly related to cough and asthma; the 
anterior, in the vestibule, to sneezing, lacrimation, 
and other catarrhal symptoms. We might com- 
pare these reflexes with certain other cases of 
reflex asthma (not hay-fever) benefited by removal 
of the tonsils. 

Bosworth regarded the continuous sneezing as 
pathognomonic and holds that the hyperemia is 
" confined entirely to the large venous sinuses, 
the capillaries proper not being congested," 
and speaks of the watery, serous discharge 
with the bluish-gray " tinge of the mucosa 
verging on opalescence, the surface of the mem- 
brane being covered with slightly viscid, watery 



92 HAY-FEVER. 

serum, which gives it a glassy, semitranslucent 
aspect." 

During an attack of hay-fever the erectile tis- 
sues of the nasal passages and the posterior throat 
become distended, the blood-vessels are engorged, 
groups of lymph-cells fill the lymphatic spaces, the 
mucous surface is crowded with migrating leuko- 
cytes (white blood-corpuscles), younger epithelial 
cells are vacuolating and proliferating, secretion is 
increased in quantity and altered in character and 
composition, sensation is heightened, intensified, 
altered, or benumbed, and the whole metabolism 
of the affected region is profoundly disordered. 
Examination of the lower borders of the turbinated 
bones will disclose the mucous membranes of the 
nasal cavities arranged in thick, loose folds, owing 
to the peculiar distribution of the network of 
arteries and veins which go to make up " cavern- 
ous tissue." It is peculiar to this tissue that it 
may suddenly be engorged with blood, extremely 
distending it, and as suddenly emptied and the 
engorgement relieved. It is especially thick over 
the inferior turbinated bones and over the lower 
and posterior part of the nasal septum, and also 
upon the lower edge of the middle turbinated 



PATHOLOGY. 93 

bone. In acute conditions the engorgement and 
distention soon subside. In chronic states the 
mucous membrane becomes markedly thickened 
and the blood-vessels enlarged and tortuous. The 
subsidence of the engorgement can not occur, and 
as a result there is a greater or less degree of 
closure of the nasal passages. 

The mucous membrane of the nasal cavities 
in hay-fever does not present the characteristic 
features of an acute inflammation. The impact of 
pollen or exciting irritant causes complete relaxa- 
tion of the large veins of the turbinated bodies 
and an exudation of serum, which relaxation 
continues so long as pollen or the irritant is in 
situ, but as soon as it is removed the normal 
caliber is again restored and the attack subsides. 
Deviations of the septum or chronic rhinitis are 
occasionally found concurrent with the disease, 
but can not be regarded as characteristic. 



94 HAY-FEVER. 



DIAGNOSIS. 

Hay-fever may be distinguished from asthma, 
common catarrh, bronchitis, acute rhinitis, remit- 
tent fever, and catarrhal conjunctivitis. The 
salient feature of hay-fever is its periodicity or 
annual recurrence. This is part of its very nature, 
is the central point of diagnosis, is its chief charac- 
teristic, and to its elucidation, Holmes says, all 
existing theories tend. Beard states that hay- 
fever is like asthma in the following points : 

1. It is hereditary; 

2. It is more or less periodic; 

3. It is paroxysmal ; 

4. It is correlated to other functional nervous 
affections ; 

5. The paroxysms are excited by great variety 
of irritants ; persons being differently affected ; 

6. It is singularly obstinate and is relieved by 
the same remedies. 

Bosworth considers hay-fever dependent upon : 

1. A neurotic habit; 

2. Pollen in the atmosphere ; 

3. A disordered condition of the nasal passages. 



DIAGNOSIS. 95 

While asthma is dependent upon : 

1. A general neurotic condition; 

2. Obscure conditions of the atmosphere; 

3. Diseased bronchial (not nasal) mucous mem- 
branes. 

It is the comparative suddenness of the onset 
as well as its sudden departure, the violent parox- 
ysms of sneezing, and the character of the nasal 
discharges which are the peculiar features of hay- 
fever. The first attacks are likely to be mistaken 
for ordinary coryza, but here the abrupt onset, the 
characteristic edematous puffiness of the eyelids, 
the absence of constitutional symptoms will indi- 
cate the difference. In children, moreover, attacks 
of hay-fever are most liable to be mistaken for 
acute colds or rhinitis, — but here, again, the above 
points may serve to distinguish, together with the 
sequence of the symptoms, the time of year, and 
the physical signs of an acute bronchitis, if it ex- 
tends so far. The approach of cold weather and 
the coincident departure of the symptoms will 
make clear a diagnosis, while the history of pre- 
vious attacks at the season of the year most favor- 
able to hay-fever, the presence of certain irritants, 
and the general condition of the bodily symptoms 



96 HAY- FEVER. 

may be of aid in distinguishing the affection. In 
acute rhinitis there are several stages, viz. : First, 
a dry stage, lasting for a fe\V, say twelve, hours; 
second, a serous discharge, lasting two or three 
days; and, third, a mucopurulent discharge for 
from three to five days, — while the entire attack 
runs its course in from five £0 ten days if no com- 
plications ensue. In hay-feter there is no dry 
stage; the discharge from- the outset is purely 
serous and never mucopurulent during the entire 
course. The nasal discharge in hay-fever is some- 
times slightly opaque, and it may contain some few 
epithelial cells and viscid mucus. In acute rhi- 
nitis examination of the nares will show an inflam- 
matory area while hay-fever shows none. Hay- 
fever is a vasomotor paresis, and is easily diagnosed 
from inflammatory coryza by the swollen bluish- 
gray appearance of the inferior turbinated bones, 
and by the fact that the first train of symptoms 
continues through to the end. Examination of 
the nares will disclose occlusion due to the swol- 
len turbinated bones lying in contact with the 
septum. The appearance of the mucous mem- 
brane itself is characteristic and only slightly 
resembles an inflammatory process. It is mark- 



DIAGNOSIS. 97 

edly swollen, not .bright red as in rhinitis, but 
bluish-gray, covered with a thin, slightly viscid, 
watery serum, giving it a glassy, semitranslucent, 
at times opalescent appearance. Again, the 
marked puffiness of the eyelids, the great suffusion 
of the eyes, the photophobia, and even epiphora 
are distinguishing features of hay-fever. 

The sensitive areas spoken of, particularly those 
on the lower and posterior parts of the septum and 
the inferior turbinated bones, are of value in differ- 
entiating hay-fever, and the markedly pronounced 
paroxysms of sneezing are very prominent in hay- 
fever. 

People are subject in the changeable climate of 
spring and early summer to catch colds, and espe- 
cially is this true of those prone to catarrh. These 
cases are sometimes mistaken for hay-fever. The 
readiness, however, with which they yield to anti- 
catarrhal treatment shows their nature. 



98 HAY-FEVER. 



PROGNOSIS. 

The prognosis is invariably good as to life. 
Sufferers often live to advanced ages. Hay-fever 
is no bar to life-insurance, but unless rationally 
treated the chances of permanent cure are very 
small. There are few exceptions to the rule that 
the tendency is, when once established, to an 
annual recurrence, unless the predisposing causes 
are removed, or there is removal of or away from 
the exciting cause. Beard states that hay-fever 
has no effect on longevity, and that, judging 
from observation and analogy, this affliction may 
act as a kind of safety-valve for the nervous 
diathesis, preventing other and more serious 
disorders, and thus becoming the friend rather 
than the enemy of life. When once attacked, 
unless properly treated, escape is rare in any 
subsequent year. Even changes in constitution 
in extreme age are no bar or protection. It 
rarely skips a year, provided locality and influ- 
ence are the same. Absolute immunity is only 
obtainable at the price of temporary exile. There 
is no proof that hay-fever is generally milder or 



PROGNOSIS. 99 

severer in certain years all over the world or 
over a country, yet evidence is satisfactory that 
in certain localities it varies greatly in different 
years. 

Now and then, but not often, the tendency to 
the disease seems to be outgrown. In one of 
Beard's cases the disease skipped two years. 
Dr. Gibbons, of California, mentions a terrible 
case in which the attacks in successive years . 
became lighter and lighter and finally disappeared 
entirely. 

With respect to increase or decrease of sever- 
ity of symptoms with advancing years there is 
no constant law. In some cases the disease 
grows milder, in others severer, in others still, 
years of comparative mildness alternate with 
years of comparative severity. The early form 
may change into the later form. There is no 
doubt, however, that attacks may change from 
the early to the late form, and vice versa, and 
in advancing years may be milder. Bosworth 
states that the younger the patient the better is 
the promise of relief; and that rose cold, belong- 
ing more especially to early life, is to be regarded 
more favorably than other forms. Macdonald 



IOO HAY-FEVER. 

has observed spontaneous disappearance in 
children, perhaps due to an increase, pari passu 
with growth and development of nervous stability. 

As regards the termination of each individual 
attack the prognosis is invariably favorable ; ces- 
sante causa, cessat effectus. There is almost equal 
certainty that with the same causative influences 
the attacks will reappear upon exposure to the ex- 
citing cause. It is peculiar, too, that the disease 
of one year's standing has proven as obstinate as 
one of from twenty to thirty years' duration. In 
these instances, it may be a question as to how 
firmly fixed has become the neurotic habit. 

W. W. Bulette, of Colorado, in 1896, as a re- 
sult of his own experience, made the assertion 
that more than eighty per cent, of hay-fever suf- 
ferers can be permanently and effectually cured. 
Thorough examination of the patient and elimina- 
tion of every possible source of irritation and 
pathologic condition is necessary. 

/ desire to be more emphatic, and from my results 
in the treatme?it of over 200 cases dining the last ten 
ears, I believe that the curability of the disease can 
not be questioned. That all cases can be cured is 
questionable ; but we can unhesitatingly say that a 



PROGNOSIS. 10 1 

majority of cases are curable, and that positive relief, 
without change of residence or inconvenience, can be 
afforded during the period of occurrence, if treatment 
is directed along the lines laid down in the following 
chapter. 



102 HAY-FEVER. 



TREATMENT. 

The proper treatment of hay-fever has always 
been a subject of many and diverse opinions; and 
the so-called specifics have been as numerous as 
the theories of causation. From time to time, 
nearly every drug in the pharmacopeia has been 
employed ; and many have been fashionable for a 
very brief period and finally abandoned. The an- 
tiseptics, the antispasmodics, the escharotics, the 
astringents, and the sedatives have one and all had 
their advocates, have flourished and fallen into dis- 
use. Early in my experience in the treatment of 
hay-fever I followed one authority after another, 
shifted from drug to drug, until finally I employed 
almost exclusively in uncomplicated cases the simple 
methods herein described. During the last ten years 
I have had under my care over 200 well-marked 
cases of hay-fever, of which I possess, in nearly all, 
complete histories, and I have not failed to relieve 
a single patient who has persisted in the treatment. 
I not only prevented the paroxysms, but subdued 
their violence and controlled the attacks when well 
established. I am free to confess that I secured 



TREATMENT. 103 

success rather empirically, and not until many 
stubborn cases had yielded could I deduce satis- 
factory conclusions. 

The logical parallel of my methods is found in 
antiseptic surgery. The ponderous technic of 
Lister is now replaced by simple antisepsis or 
surgical cleanliness; so the simple, though strict, 
sterilization of the nasopharynx is often the certain 
means of arrest of the painful phenomena of hay- 
fever. By a daily sterilization of the nares and post- 
nasal spaces the victims of hay-fever may remain in 
the city attending to their usual duties, surrounded 
by dust, or in the country amid blooming flowers, 
without any fear of the distressing symptoms — a 
consummation devoutly to be wished for by the 
great army of hay-fever sufferers. 

Some years ago, in the dispensary, I had made 
a somewhat prolonged bacteriologic study of the 
nasal secretions of young children waiting for 
treatment for various simple disorders, and it was 
found that although a child might have no consti- 
tutional indication of infection whatever, often the 
bacteria of diphtheria, pneumonia, or tuberculosis, 
as well as many unrecognizable forms of micro- 
organisms, were present in the nasal secretions. 



104 HAY-FEVER. 

Thus I was led to appreciate the well-known fact 
that the various bacteria deposited in limited num- 
bers on healthy nasal mucous membranes ultimately 
perish. Unless the general vitality and resistance of 
the mucous surfaces are lowered by internal causes, 
or an entrance is made through some local lesion, 
possibly the result of previous disease or injury, 
unhygienic environment, or overwhelming expos- 
ure, hay-fever will not occur. Conceded that an 
external irritant is necessary to cause the disease, 
to prevent or cure it we must either prevent the 
irritant from reaching the points of exposure, 
fortify these vulnerable spots, or remove or render 
inert the irritant when already lodged. In hay- 
fever the vulnerable spot is undoubtedly somewhere 
within the nasopharynx. It is now conceded that 
the nose and throat are channels for the entrance 
of the bacteria of many infectious diseases ; and I 
feel sure that as I have limited the extension of 
house-epidemics of scarlet fever, diphtheria, whoop- 
ing-cough, and measles by a carefully conducted 
antiseptic toilet of the nose and throat, in the same 
manner I have prevented the dreaded paroxysms 
in cases of hay-fever. 

All writers on this subject advocate vaguely the 



TREATMENT. IO5 

treatment of the nose and adjacent parts ; but 
almost invariably definite nasal treatment is 
directed to previous local disease or to the em- 
ployment of escharotics, astringents, or anesthet- 
ics. Antiseptic solutions are advised for their 
local action rather than with an idea of cleansing 
the nares, and are used in quantities too small to 
remove or render inert the irritant. Removal 
from the source of irritation — a complete change 
of environment during the period of recurrence — 
has been the best prophylactic means previously 
at our command, but this is most inconvenient 
and impracticable to many of the sufferers. 
Equally impracticable is such an alternative sug- 
gestion as that of Morell Mackenzie, that when 
people can not flee to the mountains or the mid- 
ocean they should remain indoors, and " if they 
must go out they ought to plug the nose with 
cotton-wool and protect the eyes by wearing 
spectacles with large frames, accurately adapted to 
the circumference of the orbit." I offer as an 
acceptable and reliable substitute for the change 
of climate a simple local treatment. 

The infection and disturbance of the nasal 
mucous membrane is undoubtedly the exciting 



106 HAY- FEVER. 

factor in originating the paroxysms, and to this 
we must confine our efforts early if we are to gain 
any success in treatment. 

The first step in the local treatment is to learn, 
by careful examination of the nasal chambers, 
whether we have present any abnormal condition 
which renders their mucous surfaces supersensi- 
tive, or any well-marked defects, such as polypi, 
deviated septums, or hypertrophies. Frequently a 
simple chronic rhinitis precedes a tendency to 
permanent turgescence of the whole nasal cham- 
ber; in such a case a free cleansing of the nasal 
mucous membrane is quite easy, but when we 
have a polypus blocking the way, or a badly de- 
viated septum, progress in treatment will be slow. 
I believe that, as a rule, local disease is only inci- 
dental and not in any way provocative, except as 
it renders the surrounding mucous membrane 
unhealthy, thus inviting infection and precipitating 
the true paroxysms. 

However, any abnormal condition existing in 
the nasal avenues must be corrected so far as pos- 
sible, because it renders complete sterilization of 
these parts difficult or impossible, and weakens the 
normal resistance of the mucous membrane, thus 



TREATMENT. IO7 

inviting periodic infection. I believe that the 
acute infective diseases, particularly in children, 
may be prevented by most thorough and repeated 
sterilization of the nasopharynx, and just as house- 
epidemics are never excusable evils so I claim 
the same to be true of hay-fever. 

Local Treatment. — The important result to be 
obtained through treatment is the prevention of 
the paroxysms, and, ultimately, the entire re- 
moval of the recurring habit periods. Years ago I 
was led to treat my hay-fever patients suffering 
with watery nose, weeping eyes, and bronchial and 
frequently asthmatic cough by cleansing the naso- 
pharynx with a hand-ball atomizer containing a 
warm solution of boric acid (ten grains to an ounce 
of water) or Dobell's solution, after which I care- 
fully wiped the mucous membrane and applied 
menthol and liquid cosmolin freely to the parts. 
This procedure afforded considerable temporary 
relief in a large number of cases when there was 
present simply turgescence of the whole naso- 
pharynx. When, however, polypi or evident 
hypertrophies existed this treatment was not suffi- 
cient. After the polypi were removed or the 
hypertrophic tissue destroyed I would continue 



108 HAY-FEVER. 

the alkaline wash, practising the sterilization and 
applications to the parts with my oily solution. 
It would be a long story to trace in detail the 
gradual abandoning of one drug after another 
from the mildest alkaline wash up to the strongest 
caustic application of Williams — the solution of 
the iodid of mercury of the strength of I : iooo up 
to I : 250. The chromic-acid application, nitrate 
of silver, carbolic acid, tincture of iodin, quinin 
solution, perchlorid of mercury, and many of the 
more powerful caustics and tissue-destroying appli- 
cations so frequently resorted to in the early his- 
tory of the treatment of the disorder, I have long 
ago discarded. These remedies, while sometimes 
possessing merit, were not lasting, and were fre- 
quently more painful than the paroxysms they 
were supposed to check ; they could only be 
resorted to in those hopeless cases in which the 
patient would willingly suffer any pain rather 
than the distressing hay-fever paroxysms. The 
stronger solution of iodid of mercury (1 1250) was 
so very severe as to often necessitate an hypo- 
dermic injection of morphin to control the agony, 
and in addition it produced an acute catarrh of a 
severe type lasting several days. 



TREATMENT. IO9 

All of the above severe caustic remedies have 
in turn occasionally proved of value; but my ex- 
perience of late years has led me to avoid all 
powerful applications. For the last ten years I 
have generally used the following solution : 

R • Sodium bicarbonate, 

Sodium borate, of each, § iss 

Carbolic acid, ^j 

Glycerin, § ij 

Rose-water (25 per cent.), . . . . q. s. O j . 

Sic — Teaspoonful to one ounce of warm water. 

This I thoroughly use in both nostrils, first by 
means of a hand-ball atomizer ; after which, with a 
curved aluminum applicator or Harrison Allen's 
nasal cotton-carrier, I very carefully swab the 
whole nasopharynx. I scrub most carefully and 
gently every portion of the mucous membrane ', being 
sure to reach between the turbinated bones and all 
around and over every slight prominence. I then as 
carefully dry the membrane with clean cotton, and 
use freely a mild solution of menthol, eucalyptus, 
and camphor in albolin, in proportions as follows : 

R . Menthol, gr. x 

Oil of eucalyptus, 3J 

Pulverized camphor, 3 ss 

Albolin, g ij. 



IIO HAY-FEVER. 

I loosely plug the nose for a few minutes to 
retain the oily application. It is important to 
sterilize most thoroughly the three sensitive areas 
of the nose, as we are unable to determine whether 
one or more may be affected, and by this mild yet 
thorough treatment we cleanse effectually the 
whole nasal chamber. 

This treatment was so extremely simple that 
for a long time I doubted the real extent of its 
value, but as so many extreme sufferers have 
expressed their great relief, and were willing and 
anxious for me to continue the applications, I 
have concluded to offer my methods in full con- 
fidence of their reliability, with a warning that 
for successful treatment the instructions for cleans- 
ing and scrubbing must be followed in the strictest 
detail. Good results need not be expected by 
simple irrigation and swabbing — the whole nasal 
mucous membrane must be thoroughly washed 
and gently scrubbed before the oily applications 
are used. 

I have found many persons who will not tolerate 
the use of carbolic acid, even in so mild a solution 
as that given above, the weakest solution frequently 
causing a severe urticaria or a painful rhinitis. 



TREATMENT. I 1 1 

When various idiosyncrasies to carbolic acid forbid 
its use, I select as the second best detergent hydro- 
gen dioxid,and commence with the following mix- 
ture : 

R . Hydrogen dioxid, 
Glycerin, 
Distilled water, of each, ^ij. 

With this I spray the nose most thoroughly, fol- 
lowing it up with plain warm sterile water to re- 
move the accumulation of foam that will neces- 
sarily collect in the nasal spaces. A few days 
prior to the date of the onset, I increase the 
strength of the hydrogen dioxid solution, using 
something like the following : 

R. Hydrogen dioxid, § iv 

Glycerin, 

Distilled water, of each, ^ij. 

This must be removed also by means of the 
sterile water, as already mentioned. In a number 
of cases I have found glycerin objectionable as a 
vehicle, producing an irritation of much annoyance. 
In such cases I omit the glycerin and substitute 
so much more distilled water. In a few cases 
the hydrogen dioxid produced an inflammation of 
the mucous membrane that would require its 



112 HAY-FEVER. 

dilution. We find so many personal idiosyncra- 
sies in a large number of hay-fever sufferers that 
one might go on indefinitely with modifications of 
treatment, but, as in general practice, it is our aim 
as successful physicians to treat the individual pri- 
marily, and we can not dogmatically hold fast to 
any special drugs. 

In the few obstinate cases, in which sterilization 
seems to provoke additional trouble, and the 
slightest manipulations of the nose and throat pre- 
cipitate violent paroxysms, I use on the nasal 
mucous membrane the following powder : 

R. Morphin. sulph., gr. iv 

Boracic acid, gj 

Powdered camphor, g ss 

Powdered starch, 3 iv. 

SiG. — To be used as a snuff frequently. 

If patients object to the use of the snuff, and 
occasionally we will find some who will do so for 
cosmetic reasons, I prescribe the following, to be 
taken internally : 

R . Tinct. of deod. opium, 3 iiss 

Spirits of chloroform, 3 ij 

Aromatic elixir, q. s. gij. 

SiG. — A teaspoonful in water every four hours for the first two 
days. (Not to be renewed.) 



TREATMENT. I I 3 

Some physicians claim that relief can not be 
afforded to hay-fever patients without using cocain 
or eucain at some time during the management of 
troublesome cases. It is very exceptionally that I 
resort to either; possibly an unusual case will re- 
quire one or more applications to control a local 
storm, yet the majority of patients never receive 
any cocain from my hand. 

In several severe cases that came to my notice 
after the disease had been well established, when I 
had no chance to conduct a preliminary course of 
sterilization, I have been forced to prescribe some- 
thing like the following : 

Menthol, gr. viij 

Boric acid, . . . . gr. xxx 

Albolin, ^ij 

Solution of Eucain " B " (4 per cent.), ^ ij. 

This is applied carefully and thoroughly on 
cotton applicators to the mucous membrane of 
the nasopharynx. It may control the attacks, and 
it frequently aborts them and keeps the patient 
decidedly comfortable. I have found the direct 
application of the remedy more satisfactory than 
the atomizer. In some cases, for a few days this 

application must be made two or three times daily. 
8 



114 HAY-FEVER. 

H. L. Swain recommends the local use of the 
aqueous extract of the suprarenal glands in cer- 
tain chronic conditions of the hay-fever type, as % 
powerful local vasoconstrictor and contractor of 
erectile tissue. The local effect can apparently be 
obtained any number of times without entailing a 
vicious habit, such as might result from cocain. 
Ingals and Ohls report that they have obtained 
much relief in these cases by the use of an ex- 
tract of suprarenal capsule prepared as follows : 
Adrenals (Armour's), 5j ; boric acid, gr. xvj ; 
cinnamon water, 5iv ; hot camphor water, §j ; 
hot distilled water, enough to make §ij. Mix, 
macerate for four hours, and filter. This solution 
remains stable for several weeks. It is used as a 
spray four or five times a day. I have not had 
occasion to resort to the local application of this 
substance, but I have had one patient who was 
distinctly benefited by internal administration in 
doses of gr. ^ to gr. j, as often as four times a 
day. He was a catarrhal young man of neurotic 
temperament, who came to me during the first 
week of his attack, and who objected to the usual 
routine sterilization of the nasopharynx. 

Surgical Treatment. — In making an analysis 



TREATMENT. I I 5 

of the abnormalities of the nasopharynx in hay- 
fever cases, the personal equation enters so largely 
that, necessarily, statistics are unreliable. What 
one observer would consider pathologic, another 
might overlook or call normal. However, I can 
safely say that in the great majority of my cases 
there was a decidedly catarrhal nasopharynx, and 
that in at least one-half there was deviated septum, 
hypertrophy of the turbinated regions, or polyp. 
In some cases a combination of all existed. In 
about ten per cent, of my cases I was satisfied 
to pronounce the anatomic conformation and the 
state of the mucous membrane as practically 
normal. 

It has been my experience that only when gross 
lesions exist is surgical treatment indicated, and 
then it should precede the usual sterilization 
methods. Indeed, so frequently successful has 
been the thorough cleansing of the nares, that in 
many cases of gross hypertrophy I have neglected 
removal. If, however, the sterilizing and cleans- 
ing treatment did not bring relief, I would resort 
to the galvanocautery or needle for hypertrophy, 
or the snare for polypi, after which my nasal 
cleansing process would be satisfactorily con- 



Il6 HAY-FEVER. 

tinued. In cases of deviated septum I rarely felt 
the necessity for correction, but most carefully fol- 
lowed out the thorough cleansing, unless the case 
presented itself some months before the expected 
paroxysm, when correction could be made safely. 

A large percentage of my patients during the 
last five years, anticipating the periods of recur- 
rence, have willingly presented themselves for 
an annual course of preliminary local treatment* 
This is extremely necessary to successfully de- 
stroy the nerve-habit and to effect a cure. 

General Prophylactic, Hygienic, and Sys- 
temic Treatment. — In old cases, when the nerve- 
habit has long been formed, treatment should 
commence at least two or, better, three weeks 
before the anticipated recurrence of the parox- 
ysms. All bodily irregularities must be corrected 
and tendencies to constipation or dyspepsia re- 
moved. Amylaceous indigestion should be cor- 
rected by the exclusion from the dietary of too 
starchy foods. For the elimination of excessive 
uric acid, or other waste products, and to relieve 
constipation, the systematic administration, morn- 
ing and night, of effervescent sodium phosphate is 
invaluable. If the appetite is not good, the regu- 



TREATMENT. 1 1 7 

lar use of the tincture of nux vomica, ten to 
twenty drops three times a day, is strongly indi- 
cated. In anemic cases pills of carbonate of iron 
or, probably still better, the pills of valerianate of 
quinin, iron, and zinc are necessary. In nervous 
cases with anemia, valerianate of zinc, one grain 
with two grains of the compound asafetida pill, 
two or three times a day (after Morell Mackenzie), 
will be found valuable. Careful diet, a tranquil 
mind, and moderate exercise are essential. Out- 
door exercise, with a daily tepid bath followed by 
vigorous friction of the whole body, will help to 
eliminate waste material. The patient should not 
unnecessarily expose himself to direct rays of the 
sun, as they are calculated to excite intense reflex 
irritation of the sensitive nerve centers. Much 
trouble may be averted by the use of a sunshade 
or umbrella and by the avoidance of exercise in 
the sun. 

It must be understood that with the general 
hygienic and constitutional treatment the course 
of local prophylaxis by daily sterilization is most 
necessary. 

The treatment of neurasthenic cases, or 
those in which a decided derangement of the gen- 



Il8 HAY- FEVER. 

eral system as well as of the nervous energy exists 
prior to the attack, requires the greatest tact and 
skill. If there is little local catarrhal disturbance 
there will be great difficulty in combating the dis- 
ease in the face of the depressed vitality and les- 
sened nervous resistance. In such cases I place 
the patients upon a diet, somewhat like that in the 
appended list, and urge strict adherence to it. 
After obtaining careful urinary analysis and other 
clinical data, I often further specialize in the diet, 
or I may increase the variety according to the 
needs of the individual. In these cases I always 
urge the drinking of large quantities of water, un- 
less there is some strong contraindication. Neu- 
rasthenics will often avoid water between meals. I 
at once order systematic massage. If the patient 
does not care for a masseur, I order a daily tepid 
bath of a temperature between 8o° and 85 ° F., 
with a coarse towel rubbing, followed by a douche 
of cold water along the spine. This should be 
continued for at least two weeks prior to the onset 
of the paroxysms. 

Rest for the overtaxed function is imperatively 
demanded. Unfortunately, this is easier prescribed 
than carried out. In wealthy patients the Weir 



TREATMENT. 1 1 9 

Mitchell rest-cure often gives brilliant results. In 
other cases a change of scene and a temporary rest 
from business or society may be accepted when the 
sanitarium would be out of the question. Quiet 
resorts on the seacoast or in the mountains are 
desirable. Nothing is better than two or three 
weeks on the ocean. A compromise may be ob- 
tained by having the patient give up a portion of 
the daily duties and go to bed earlier at night. 
The patients should not be allowed to discuss their 
ailments too freely. Horseback riding, bicycling, 
rowing, and walking — in fact, any outdoor diver- 
sion not too violent — are to be recommended. 

If the patient suffers from insomnia, careful ad- 
ministration of a hypnotic may help to reestablish 
the sleep-habit. .At first give a warm bath, and a 
glass of warm milk or malted milk before retiring. 
If this and other similar measures do not avail, ten 
grains of trional powder may be given two hours 
before going to bed. If the patient is accustomed 
to wake after a short sleep, the trional should be 
given at bedtime. Full amounts of sleep are 
necessary to neurasthenics. Depressants, such as 
the bromids, chloral, and the opiates should be 
avoided. Any coexistent gastric or cardiac trouble 



120 HAY-FEVER. 

must be carefully treated, and the bowels kept open 
regularly. 

The diet that I find most desirable to follow, 
generally speaking, is that which is applicable to 
the gouty or uric acid diathesis. 

General Rides. — The diet should be liberal, but 
not stimulating, with moderation in animal foods, 
and very little of foods having a tendency to pro- 
duce acids in the system, such as starches, sugars, 
fats, and fermented liquors. Patients may take 
soups — clear or vegetable — and weak beef-tea or 
broths. 

Fish. — Fresh fish and raw oysters. 

Meats. — To be taken once a day only — mutton, 
chicken, underdone roast, sweetbread. 

Eggs. — Moderation. White of eggs, raw, or 
shirred in drinks, such as lemonade, occasionally. 

Farinaceous. — In small quantities. Toast, stale 
bread, bread from whole wheat, rye bread, milk- 
toast, rice, crackers. 

Vegetables. — Fresh, green varieties preferable ; 
celery, lettuce, watercress, cucumbers, onions, 
cabbage, salads, sparingly of baked potatoes, young 
peas, string beans, and spinach. 

Desserts. — Oranges, lemons, apples, apricots, 



TREATMENT. 121 

pears, peaches, cherries, blanc mange (not after 
meals, however), stewed fruit. 

Beverages. — Water, plentifully, especially before 
meals; plain soda, milk, buttermilk, weak tea or 
coffee (without sugar), toast-water, lemonade. Min- 
eral waters, such as Saratoga Vichy, Berkley 
(Hot Springs), Lithia Water, Carlsbad, and Crab 
Orchard. 

Stimulants. — Light Hock ; Bordeaux in small 
quantities and well diluted. 

Articles Forbidden. — Patients must avoid rich 
soups, hard-boiled eggs, fried and made dishes of 
all kinds, entrees, pickles, spices, veal, pork, duck, 
goose, salmon, lobster, crab ; preserved, dried, and 
salted meats ; salt fish, pickled pork, asparagus, old 
peas, beans, tomatoes, mushrooms, truffles, dried 
fruit, preserves, pies, pastry, rich puddings, patties, 
new bread, cheese, sweets, malts, sweet wines, 
strawberries, rhubarb, cider, fermented drinks, beer. 

Asthma. — About five to ten per cent.of my whole 
number of hay-fever patients have suffered more 
or less from asthma. Asthma, as a sequel in these 
cases, manifests itself about the end of one week or 
ten days after the expected paroxysms of hay-fever, 
and is induced usually by some undue exposure or 



122 HAY-FEVER. 

a damp or rainy day. My asthmatic patients, I 
find, were among those irregular in treatment, or 
those who had first called late in the disease. In 
these cases much mucus had accumulated in the 
larger tubes. If I can not clear the bronchial tubes 
by an emetic dose of ipecac, I prescribe somewhat 
as follows : 

Potassium iodid, 3 ss 

Ammonium muriate, 3 ss 

Syrup of Yerba Santa, gj. 

A teaspoonful exhibited every two hours gen- 
erally brings relief. A number of asthmatic patients 
require a solution of nitroglycerin, one per cent. 
Of this, one drop every three hours for two or 
three days is given. Occasionally it seems im- 
perative to give morphin. Some of my asthmatics 
have informed me that they can bring about imme- 
diate relief by plunging both hands in hot water 
and taking a drink of whisky, followed by a large 
draft of hot water. It is possible for some per- 
sons to voluntarily combat their asthmatic attacks, 
and for this reason they should be encouraged to 
practise certain breathing exercises until they can 
in a measure control their respiratory apparatus. 
Asthmatics usually have, however, a preexistent 



TREATMENT. I 23 

catarrhal state of the bronchial tubes, which ex- 
hibit marked vasomotor changes on slight irrita- 
tion. If I see these patients early, I prescribe five- 
minim capsules of the oil of sandalwood four 
times a day, and by the time their period arrives, 
the bronchitis is fairly well cleared up. 

The inhalation of the fumes of burning niter- 
paper or specially prepared powders, or of cigar- 
ettes, gives relief in many cases. The powders 
used at the Brompton Hospital by Sydney Martin 
contain one part each of anise and niter, two parts 
of stramonium leaves, and five grains of tobacco to 
the ounce ; one teaspoonful is to be burnt on a 
plate and the fumes inhaled. A pill containing % 
of a grain of morphin, with y^- of a grain of 
atropin sulphate, given at bedtime, is sometimes 
useful in connection with the inhalations. Extract 
of stramonium (-^ of a grain) may be substituted 
for the atropin. 

S. Solis-Cohen has used successfully the follow- 
ing formula : 

R. Morphin sulph., gr. \-\ 

Strychnin sulph., g r - eWV 

Hyoscin hydrobrom., ........ gr. -%^-q. M. 

Sig. — Give hypodermically at bedtime. 



124 HAY-FEVER. 

The following may be administered at night : 

R. Camphor, gr. ss 

Dover's powder, gr. vj 

Sugar of milk, gr. x. 

Make four powders. 
SlG. — Take one on retiring. 

Van Sweringen calls attention to a line of treat- 
ment in a very obstinate case of bronchial asthma 
that was attended by remarkable results. The 
attack had lasted for two weeks, during which 
time all the antispasmodics had in turn been ex- 
hausted, and the patient had secured but a period 
of two hours' freedom at any one time. Finally, 
based on the theory that if asthma was reflex it 
must be under the control of Setschenow's inhibi- 
tory center, and that anything that would stimu- 
late the inhibitory center would lessen the reflex- 
spasm, quinin and strychnin were given, with 
excellent results. The dose of the quinin was 
seven grains. The extract of nux vomica was 
given in ^-grain doses, and to this was added y£ 
of a grain of codein sulphate. In the interval 
the iodids were continued. 

However, the use of sedatives and inhalations 
must be limited, especially in the milder and un- 



TREATMENT. 125 

complicated forms of asthma, while efforts to benefit 
the patient's general condition are strongly indi- 
cated. Diet is an important part of the treatment 
of many cases. Not all cases of asthma are due 
to uricacidemia, but nearly all cases are benefited 
by attention to the diet and elimination of excess 
uric acid. 

Of remedies that may be continuously admin- 
istered to patients who have frequently recurring 
attacks, two are most constantly used — namely, 
iodid of potassium and arsenic. The iodid maybe 
most conveniently given with stramonium, as in 
the mixture devised by Martin, which consists of 
Y^ of a grain of extract of stramonium, two grains 
of extract of licorice, three grains of iodid of 
potassium, and five minims of chloric ether. This 
mixture may be given two or three times daily in 
cases of asthma. It possesses two disadvantages, 
however. The stramonium leads, in some cases, to 
paralysis of accommodation, but by diminishing 
the dose, the patient soon ceases to experience dis- 
comfort from the remedy. If given alone, the iodid 
must be administered in five-grain doses two or 
three times daily, the medicine being discontinued 
from time to time. Arsenic by itself, in doses of 



126 HAY-FEVER. 

three minims of the liquor arsenicalis, is a useful 
remedy for continuous administration in asthma, 
and it may be combined with potassium iodid 
(three to five grains) in a mixture. Hydrothera- 
peutic treatment is of use in some cases of asthma. 
The patient should be accustomed to gradually 
colder baths of short duration with douches. 



BIBLIOGRAPHY. 



1565. 
Botallus (L.), Comment, duo, alter de Medici, alter de 
^Egroti Unnere, Lugduni, 1565, p. 23. 

1673. 
Binningerus (J. N.), Obs. et Curat. Med. Cent, quinquae, 
Cent, secundo, Obs. lxxxvi, 1673. 

1698. 
Floyer (John), London, 1698, On Asthma. 

1707. 
Van Helmont (J. B.), Asthma et Tussis, cap. x, Opera 
omnia, p. 344. Hafniae, 1707. 

1712. 
Acta nat. curios. Ephemerides, 1712-17, Dec. Ill, An. v and 
vi, obs. 193. 

1819. 
Bostock (J.), Case of a Periodical Affection of the Eyes 
and Chest. Med.-Chir. Tr., Lond., 1819, x, 161-165. 

1824. 
Schweigger-Seidel ( F. G.), De febrium ^Estivalium origine 
atque natura, 8. Halae, 1824. 

1828. 
Schuler (J. B.), Das Sommerfieber am Mittelrhein im Jahre 
1827. Jahrb. d. Phil.-Med. Gesellsch. zu Wurzb., 1828, i, 
2. Heft, 61-72. 

127 



128 HAY-FEVER. 

Bostock (J.), Of Catarrhus ^Estivus. Med.-Chir. Tr., Lond., 
1828, xiv, 437-446. 

1829. 
Gordon (W.), Observations on the Nature, Cause, and 
Treatment of Hay-asthma. Lond. M. Gaz., 1829, iv, 
266-269. 

1830. 
Elliotson, Lancet, Lond., 1830-31, ii, 370-373. 

1831. 
Elliotson, Hay-fever; Information Solicited. Lond. M. 

Gaz., 1831, viii, 411-416. 
Prater (A.), Lancet, Lond., 1831, ii, 445. 

1833. 
Elliotson, Catarrhus ^Estivus, or Hay-fever. Med. Gaz., 
Lond., 1833, x ^» 164-171. 
Also, Boston M. and S. J., 1833, vii, 341-347. 

1838. 
Schwandner (W. F.), Casus asthmatis thymici cum pneu- 
monia conjuncti, 8. Tubingas, 1838. 

1842. 
Scott (R. W.), On Bronchorrhcea ^Estiva, or Hay-fever. 

Prov. M. and S. J., Lond., 1842, iv, 123. 
Cheyne (R. R.), Lond. M. Gaz., 1842-43, xxxi, 329. 

1843. 
King (T. W.), On Summer Asthma. Lond. M. Gaz., 1843 
xxxii, 671-675. 

1846. 
Swett, Hay-asthma, N. York M. J., 1846, vi, 10. 

1850. 

Gream (G. T.), On the Use of Nux Vomica, as a Remedy 
in Hay-fever. Lancet, Lond., 1850, i, 629. 



BIBLIOGRAPHY. 1 29 

1851. 
Mackenzie (F. W.), Remarks on the Nature and Treatment 
of Hay-fever. Lond. J. M., 1851, iii, 637-643. 

1852. 
Kirkman (W. P.), Prov. M. and S. J., Lond., 1852, 360. 

1853. 
Wey (W. C.), Hay-asthma. Tr. M. Ass. South. Central 
N. Y., Auburn, 1853, 78-82. 

1856. 
Kunkler (G. A.), Med. Counsellor, Columbus, 1856, ii, 605. 

1857. 
Hay-asthma, Boston M. and S. J., 1857, lvi, 316. 
Ellis (W. R.), On the Treatment of Hay-fever. Lancet, 

Lond., 1857, ii, 24. 
Palmer (S.), Treatment of Hay-fever. Lancet, Lond., 

1857, ii, 127. 

1859. 
Laforget, Union med., Par., 1859, 2 s -» i y > 550—552. 
Phcebus (P.), On Hay-asthma. Lancet, Lond., 1859, "» 

655. 

I860. 
Catarrhe d'ete ou flevre de foin. Abeille med., Par., i860, 

xviii, 38. 
Catarro (Del) di estate, o asma del fleno. Morgagni, 

Napoli, i860, iii, 122-128. 
Cornaz, De 1'existence du catarrhe des foins en Suisse. 

Reponse au professeur Phcebus. £cho med., Neuchat., 

i860, iv, 307-318. 
Laforgue, Catarrhe d'ete. Gaz. d. Hop., Par., i860, xxxiii, 

44. 

Also, Gaz. hebd. de med., Par., i860, vii, 67. 
9 



I30 HAY-FEVER. 

Perey (L.), Contribution a l'etude de Tasthme des foins en 
Suisse. Echo med., Neuchat., i860, iv, 595-598. 

Phoebus (P.), Das Heufieber. Med. Ztg., Berl., i860, n. F., 
iii, 92. 

Phoebus (P.)> Circulare relativ a la maladie connue sous 
les noms de catarrhe, bronchite, ou asthme d'ete, et 
sous ceux de fievre ou asthme des foins. Echo med., 
Neuchat., i860, iv, 304-307. 

1861. 
Darrach (J.), Strychnia in Hay-fever and Influenza. Mary- 
land and Virg. M. J., Richmond, 1861, xvi, 106-109. 

1862. 
Hervier, Trois observations de catarrhe d'ete sans fievre 

de foin. Gaz. hebd. de med., Par., 1862, ix, 169. 
Phoebus (P.), Der typische Friihsommer-Katarrh, oder das 

sogenannte Heufieber, Heu-Asthma. 8°. Giessen, 1862. 

1863. 
Smith (W. A.), Observations on Hay-fever. Med. Times 

and Gaz., Lond., 1863, N. S., ii, 535. 
Windsor (J.), The Cause of Hay-fever. Med. Times and 

Gaz., Lond., 1863, ii, 681. * 

1865. 
Bird (J.), Hay-fever. Brit. M. J., Lond., 1865, ii, 73. 
Herrier, Ann. Soc. de med. de St. Etienne et de la Loire, 

1865, ii, 36-39. 
Smith (W. A.), Observations on Hay -fever, Hay-asthma, or 

Summer Catarrh. 3d ed. 8vo. Lond., 1865. 
Smith (W. A.), Observations on Hay -fever, Hay- asthma, or 

Summer Catarrh. Med. Mirror, Lond., 1865, ii, 342-352. 

1866. 
Price (T. T.), Autumnal Catarrh, or Hay-asthma. Tr. M. 
Soc. N. Jersey, Newark, 1866, 162-165. 



BIBLIOGRAPHY. I 3 I 

1S67. 
Pirrie (W.), On Hay-asthma. Med. Times and Gazette, 

Lond., 1867, ii, 2, 30. 
Pirrie (W.), On Hay-asthma and the Affection Termed 

Hay-fever. 8vo. London, 1867. 
Strieker (W.), Heufieber. Arch. f. path. Anat., etc., Berl., 

1867, xli, 292. 

1868. 
Ferber (R. H.), II. Der typische Fruhsommer-Katarrh. 

Arch. d. Heilk., Leipz., 1868, ix, 556-558. 
Yearsley (J.), The Local Treatment of Hay-fever. Med. 

Press and Circ, Dublin, 1868, iii, 477. 

1869. 

Kernig (W.), St. Petersb. med. Ztschr., 1869, xvii, 17-29. 

Zoja (G.) and De Giovanni (A.), Sopra la febbre del fleno 
e l'azione del solfato neutro di chinino su alcuni infu- 
sori. Gazz. med. Ital. Lomb., Milano, 1869, 6 s., ii, 307. 

1870. 
Cooke (A. M.), Hay-fever. Eclect. M. J., Cincin., 1870. 

xxx, 84. 
Moore (G.), Summer Catarrh, or Hay-fever: Its Causes, 

Symptoms, and Treatment. i2mo. Lond., 1870. 
Roberts (W. C), Catarrhus ^Lstivus. Med. Gaz., N. Y., 

1870, v, 225 ; 1870-71, vi, 15. 

1871. 
Ferber (R. H.), Das Helmholtz'sche Yerfahren gegen das 

Heufieber. Ibid., 1871, ^cii, 555. 
Thompson (E. S.), Notes of a Lecture on Hay-fever. Brit. 

M. J., Lond., 1871, i, 58-60. 

1872. 
Barratt (R.), Hay-fever non-estival. Med. Times and Gaz., 
Lond., 1872, i, 721. 



I32 HAY-FEVER. 

Gueneau de Mussy (N.), Sur la rhino-bronchite spas- 
modique ou fievre de foin. Gaz. habd. de med., Par., 

1872, 2 s., ix, 9, 35. 

Also, Art. med., Brux., 1872, viii, 24, 41, 66, 86. 
Also, in his Clin, med., 8, Par., 1874, i, 519-564. 

Herbert (A.), Etude sur la maladie de foin, rhino-bron- 
chite spasmodique. 4 . Paris, 1872. 

Smith (W. A.), On Hay-fever. Med. Press and Circ, 
Lond., 1872, xiv, 42. 

Villemsens (L.), Etude sur le catarrhe spasmodique d'ete, 
dit catarrhe de foin, rhino-bronchique spasmodique. 4 . 
Paris, 1872. 

Waters (A. T. H.), Clinical Remarks on So-called Hay- 
fever. Brit. M. J., Lond., 1872, i, 4. 

Wyman (M.), Autumnal Catarrh, 8vo. N. Y., 1872. 

1873. 

Blackley (C. H.), Experimental Researches on the Causes 
and Nature of Catarrhus ^Estivus (Hay-fever or Hay- 
asthma). 8vo. Lond., 1873. 

C, The White Mountains and Hay-fever. Clinic, Cincin., 

1873, v » 213-215. 

Moss (W.), Hypodermic Injection of Sulphate of Morphia, 
in Autumnal Catarrh. Am. J. M. Sc, Phila., 1873, N. S., 
lxv, 275. 

1874. 

Beard (G. M.), To Those Suffering from Hay-fever. Second 
circular of inquiry. Arch. Electrol. and Neurol., N. Y., 

1874, i, 273-279. 

Binz, An Experimental Observation on Hay-fever. Prac- 
titioner, Lond., 1874, xii, 269-272. 

Bradbury (J. B.), Treatment of Hay-fever. Brit. M. J., 

- Lond , 1874, i, 514. 

Brandeis (R. C), Remarks on Hay-fever, with Cases. Am. 
Prac, Louisville, 1874, x » 24-26. 



BIBLIOGRAPHY. 1 33 

Glas (O.), Upsal a Lakaref. Forh., 1874, ix, 98-101. 
Hoover (T. C), Hay-fever Successfully Treated. Am. J. 

M. Sc, Phila., 1874, N. S., lxvii, 379. 
Liihe (F.), Zum Heufieber. Deutsches Arch. f. klin. Med., 

Leipz., 1874, xiv, 426, 614. 

1875. 
Zuelzer (W.), Heufieber. Handb. d. spec. Path. (Ziemssen), 
Leipz., 1874, ii> 2 - Tn -» 5 I 4~526. 

Also, Transl., Cycl. Pract. M. (Ziemssen), N. Y., 1875, ii, 
539-552. 

1876. 
Baynes (D.), Hay-fever. Pub. Health Mag., Montreal, 

1876, i, 353-35B. 

Beard (G. M.), Hay-fever, or Summer Catarrh: Its Nature 
and Treatment. Including the early form, or "rose 
cold"; the later form, or "autumnal catarrh," and a 
middle form, or " July cold," hitherto undescribed. i2mo. 
N. Y., 1876. 

Beard (G.), New Facts and Suggestions Relating to Hay- 
fever. Med. Rec, N. Y., 1876, ii, 650-654. 

Segur (B. A.), The Pollen of Rag-weed (Ambrosia artemisiae- 
folia) the Cause of Hay-fever. Proc. M. Soc, County 
Kings, Brooklyn, 1876, i, 165-167. 

1877. 
Beard (G.), The Nerve Theory of Hay-fever. Med. Times 

and Gaz., Lond., 1877, ii, 385. 
Beard (G.), The Successful Treatment of Hay-fever. Med. 

Rec, N. Y., 1877, xii, 509. 
Bell (J. E.), Hay-fever. Med. and Surg. Reporter, Phila., 

1877, xxxvii, 461-465. 

Blackley (C. H.), Bemerkungen iiber Dr. G. J. Patton's Ex- 
perimente iiber Heufieber. Arch. f. path. Anat., etc., 
Berlin, 1877, lxx, 429-443. 



134 HAY-FEVER. 

Also, trans. Abstr. Med. Times and Gaz., Lond., 1877, 

iii 243. 

Evans (T. N.), Hay-fever. Virginia M. Month., Rich- 
mond, 1877, iv, 167-175. 

Marsh (E. J.), Hay-fever, or Pollen Poisoning. Trans. M. 
Soc. N. J., Newark, 1877, 86-109. 
Also, reprint. 

Patton (G. F.), Einige Erfahrungen iiber Heufieber. Arch, 
f. path. Anat., etc., Berl., 1877, lxix, 531-533. 

Wyckoff (R. M.), The Adirondacks and " Hay-fever." 
Proc. M. Soc. County Kings, Brooklyn, 1877, ii, 172-176. 

1878. 

Beard (G.), Peculiar and Unusual Symptoms of Hay-fever. 
Ibid., 1878, xiv, 348. 

Pfuhl (F.), Berl. klin. Wochenschr., 1878, xv, 772. 

United States (The) Hay-fever Association. Med. and Surg. 
Reporter, Phila., 1878, xxxix, 360. 

Wey (W. C), Hay-fever versus Paralysis of the Dia- 
phragm. Med. Rec, N. Y., 1878, xiv, 289. 

Wood (W. J. H.), Salicylic Snuff in Hay-fever. Brit. M. J., 
Lond., 1878, ii, 101. 

1879. 

Giffo (P.), Quelques Considerations sur la fievre des foins, 
et principalement de la conjonctivite et de l'otite dans 
cette maladie. Ann d. mal. de l'oreille et du larynx. 
Par., 1879, v » 2 97~ 2 99- 

Giffo (P.), Considerations generates sur la fievre des foins, 
et particulierement de la conjonctivite dans cette mal- 
adie. Rec. d'ophthal., Par., 1879, 3 s -> l > 459~4^4- 

Yelvington (C. H.), Grindelia robusta and Yerba santa in 
Hay-fever. New Preparations, Detroit, 1879, ***, I 4 I - 

Hay-fever. Med. Herald, Louisville, 1879-80, i, 248-250. 



BIBLIOGRAPHY. 1 35 

Sebastian (C. M.), A Novel and Successful Remedy for Hay- 
fever. Med. Herald, Louisville, 1879-80, i, 159. 

Outsider (An), Description of Hay-asthma. From N. York 
World. Gaillard's M. J., N. Y., 1880, xxx, 451. 
Also, Pacific M. and S. J., San Fran., 1879-80, xxii, 342. 

I88O. 
Blackley (C. H.), Hay-fever : Its Causes, Treatment, and 

Effective Prevention. 2d ed. 8vo. Lond., 1880. 
Lindseth (E. B.), Norsk. Mag. f. Laegevidensk., Christiana, 

1880, x, 464-466. 

1881. 

Atkinson (F. P.), The Treatment of Hay-fever. Brit. M. J., 
Lond., i88i,ii, 81. 

Blackley (C. H.), On the Treatment and Prevention of Hay- 
fever. Lancet, Lond., 1881, ii, 371. 

Hannay (J. B.), Treatment of Hay-fever. Nature, Lond., 

1881, xxiv, 485. 

Mann (E. C), The Chloro-phosphide of Arsenic in Hay- 
fever. Gaillard's Med. Jour., N. Y., 1881, xxxii, 9. 

Thorowgood (J. C), Practical Remarks on the Treatment 
of Summer Catarrh and Hay-asthma. Lancet, Lond., 
1881, ii, 82. 

Williams (W. M.), Hay-fever. Nature, Lond., 1881, xxiv, 
510. 

Daly (W. H.), On the Relation of Hay-asthma and Nasal 
Catarrh. Tr. Am. Laryngol. Ass., N. Y., 1881, iii, 164- 
168. 
Also, Arch. Laryngol., N. Y., 1882, iii, 1 57-161. 

1882. 
Townsend (M. M.), Hay-fever, Asthma, and Chronic 

Catarrh. i2mo. Grinnell, 1882. 
Daly (Wm. H.), On the Relation of Hay-asthma and 

Chronic Naso-pharyngeal Catarrh. Monograph, 1882. 



I36 HAY-FEVER. 

1883. 
Boyd (S. S.), Hay-fever. J. Am. M. Ass., Chicago, 1883, i, 

631. 
Ferguson (R. M.), Hay-fever. Louisville M. News, 1883, 

xvi, 241-243. 
Hack (W.), Heufieber. Wien. Med. Wochenschr., 1883, 

xxxiii, 405-410. 
Phillips (W. F.), The Treatment of Hay-fever. Brit. M. J., 

Lond., 1883, ii, 69. 
Roe (J. O.), The Pathology and Radical Cure of Hay-fever, 

or Hay-asthma. N. York M. J., 1883, xxxvii, 509, 540. 

Also, Abstr.,Med. News, Phila., 1883, xlii > l6 9- 
Sajous (C. E.), Notes on Hay-fever. Med. and Surg. Re- 
porter, Phila., 1883, x ^ lx > 675-678. 
Sufferer (A), Reply to Correspondent. Brit. M. Jour., 1883, 

i, 1315. 
Woodbury (Frank), Etiology of Hay-fever. Phila. Med. 

Times, Dec. 1, 1883, l 7S- 

1884. 

Allen (H.), On the Treatment of Hay-fever and Allied Dis- 
orders. Am. J. M. So., Phila., 1884, N. S., lxxxvii, 156- 
164. 

Mackenzie (J. N.), Coryza Vasomotoria Periodica in the 
Negro. Med. Rec, Oct. 18, 1884. 

Mackenzie (J. N.), A Contribution to the Study of Coryza 
Vasomotoria Periodica, or So-called " Hay-fever." Med. 
Rec, N. Y., 1884, xxvi, 59-63. 

Paget (W. D.), A Few Remarks on Hay-fever. Brit. M. J., 
Lond., 1884, i, 1203. 

Pruritic Rhinitis (discussion). St. Louis M. and S. J., 1884, 
xlvii, 48, 55. 

Rumbold (T. F.), Pruritus Rhinitis Catarrhalis. St. Louis 
M. and S. J., 1884, ix, 449. 



BIBLIOGRAPHY. 137 

Rumbold (T. F.), Rhinitis Pruritus, or Itching Nasal Catarrh. 

Weekly M. Rev., St. Louis, 1884, iv, 409, 426. 
Sajous (C. E.), Hay-fever and Its Successful Treatment. 

N. Y. Med. J., 1884, xl, 629-633. Tr. Am. Laryngolog. 

Ass., N. Y., 1884, vi, 106-116. 
Seiler (C), Hay-fever and Its Treatment. Rep. Alumni 

Ass., Phila. Coll. Pharm., 1884-85, xxi, 75-86. 

1885. - 

Ayres (S. C), Cocaine in Hay-fever. Cincin. Lancet and 
Clinic, 1885, N. S., xv, 317. 

Bartholow (Roberts), Note on the Use of Cocaine in Hay- 
fever. Phila., 1885, 5 I, 8vo. 

Cheatham (W.), Is There a Cure for Hay-fever ? Louisville 
M. News, 1885, xx, 113-116. 

Ingals (E. F.), Hay-fever : Its Cause and Cure. M. J. and 
Exam., 1885, li, 1161-1163. 

Mackenzie (J. N.), Observations on the Origin and Cure of 
the Disease Called " Hay-asthma." Tr. M. and Clin. 
Fac, Maryland, Bait., 1885, 216-221. 

Mackenzie (J. N.), Observations on the Origin and Cure of 
the Disease Called " Hay-asthma." Maryland Med. J., 
Bait., 1885, xm » 74- 

Mackenzie (J. N.), Review. Hay-fever: Its Etiology and 
Treatment. By M. Mackenzie. Am. J. M. Sc, Phila., 
1885. 

Mackenzie (Morell), Hay-fever : Its Etiology and Treat- 
ment. 3d ed., Lond., 1885, 54 pp., 8vo ; 4th ed., Lond., 
1887, 96 pp., 8vo. 

Robinson (B.), Note on the Therapeutics of Hay-fever (so- 
called). Med. Rec, N. Y., 1885, xxviii, 425. 

Sajous (Chas. E.), Hay-fever and Its Successful Treatment 
by Superficial Organic Alteration of the Nasal Mucous 
Membrane. Phila., 1885, F. A. Davis, 103 pp., i2mo. 



138 



HAY-FEVER. 



Stucky (J. A.), Pruritic Catarrh, or Hay-fever: Its Treat- 
ment. St. Louis M. and S. J., xlviii, 466-475. 

Thomas (R. H.), Report of a Case of So-called Hay-fever 
Treated by Galvano-Cautery. Med. News, Phila., 1885 
xlvi, 228-230. 

Watson (J.), Cocaine in Hay-fever. Med. Bull., Phila. 
1885, vii, 268-270. 

Ziem, Ueber Rosenschnupfen. Monatschr. f. Ohrenh., Berl. 
1885, xix, 167. 

Beschomer, Ueber Heufieber und dessen Behandlung 
Jahresb. d. Gesellsch. f. Nat. u. Heilk. in Dresd., 1885-86 
3-4o. 

Holmes (E. W.), Cocaine in the Treatment of Hay-fever 
Phila. Med. Times, 1885-86, xvi, 561. 

Muckey (F. P.), Hay-fever. Northwest Lancet, St. Paul 
1885-86, v, 341-346. 

1886. 

Bishop (S. S.), Cocaine in Hay-fever. J. Am. M. Ass., 

Chicago, 1886, vi, J41-144. 
Blum (J.), Periodical Hyperesthetic Rhinitis. Maryland 

M. J., Bait., 1886, xv, 121-124. 
Bpsworth (F. H.), Hay-fever, Asthma, and Allied Affections. 

N. Y. M. J., 1886, xliii, 462, 488. 
Da Costa (J. M.), Remarks on the Treatment of Rose-cold 

and Hay-fever by Cocaine. Tr. Coll. Phys., Phila., 1886, 

3 s., viii, 197-203. 
Hack, Ueber Catarrhus Autumnalis und Heufieber. 

Deutsche med. Wochenschr., Berl., 1886, xii, 141-144. 
Lindley (W.), Hay-fever in Southern California. South. 

Cal. Practitioner, Los Angeles, 1886, i, 263-267. 
Logan (J. E.), A Few Cases of Hay-fever and Its Compli- 
cations. Kansas City Med. Rec, 1886, iii, 327. 
Mackenzie (J. N.), The Production of the So-called " Rose 

Cold" by Means of Artificial Rose, with Remarks and 



BIBLIOGRAPHY. 1 39 

Historical Notes. Am. J. M. Sc, Phila., 1886, N. S., xci, 

45-57- 

Mulhall (J. C), Recent Progress in the Treatment of Hay- 
fever. St. Louis Coun. Med., 1886, xv, 97-103. 

Robinson (B.), A Contribution to the Study of Hay-fever 
(so-called). Med. News, Phila., 1886, xlix, 59-62. 

Rumbold (T. F.), The Special Hygiene of Asthmatics, and 
Those Suffering from Pruritic Rhinitis. Am. Pract. and 
News, Louisville, 1886, N. S., ii, 388-391. 

1887. 

Bishop (S. S.), Hay-fever. J. Am. M. Ass., Chicago, 1887, 
ix, 103-107. 

Bishop (S. S.), Hay-fever. First Prize Essay of U. S. Hay- 
fever Association for 1887. Repr. from J. Am. M. Asso., 
1887. 

Bishop (S. S.), Pathology of Hay-fever. Tr. Inter. M. 
Cong., IX, Wash., 1887, v, 52-78. 

Butterfield (S. A.), Hay-fever. Med. Reg., Phila., 1887, 
i, 402. 

Clark (Sir A.), The Cavendish Lecture on a Speedy and 
Sometimes Successful Method of Treating Hay-fever. 
Lancet, Lond., 1887, h 1169-1171 ; Brit. M. J., Lond., 
1887, i, 1255-1257. 

Klingensmith (J. P.), Hay-asthma. Greensburg, Pa., 1887. 
8 pp., i2mo. Tr. Inter. M. Cong., Wash., IX, 1887, iv, 
60-67. 

Roe (J. O.), Hay-fever. Analysis of 42 cases. N. York 
M. J., 1887, xlvi, 255-259. 

Rumbold (T. F.), Surgical Methods for the Relief of Pru- 
ritic Rhinitis. J. Am. M. Ass., Chicago, 1887, viii, 5-8. 

Thomas (R. H.), A Contribution on the Causes and Treat- 
ment of So-called Hay-fever and Allied Affections. Tr. 
Internat. M. Cong., IX, Wash., 1887, iv, 7-1 1. 



IzJ-O HAY-FEVER. 

United States Hay-fever Asso. Manual of the Asso. for 

1887. Lowell, 1887, S. W. Huse & Co., 40 pp., i2mo. 
Capp (W. M.), Hay-fever, with Some Notes on Palliative 

Treatment. Phila. M. Times, 1887-88, xviii, 196-199. 

1888. 
Bishop (S. S.), The Pathology of Hay-fever. J. Am. M. 

Ass., Chicago, 1888, x, 317-320. 
Genth (C), Therapeutics of Hay-fever. Brit. M. J., Lond., 

1888, i, 1268. 

Kinnear (B. O.), Hay-fever as a Disease of Central Nervous 
Origin, etc. Med. Rec, N. Y., 1888, xxxiv, 32-36. 

Kitchen (J. M. W.), A Contribution to the Study of Hay- 
Fever. Med. Rec, N. Y., 1888, 628. 

Lermoyez, Sur la pathogenie de Tasthme de foin. Ann. de 
mal. de PoreiUe, du larynx, etc. Par., 1888, xiv, 140-150. 

Lippincott (E.), Hay-fever, or Rhinitis Vasomotoria Period- 
ica, and Its Radical Cure. Chicago, 1888, Gross & Dell- 
ridge, 78 pp., i2mo. 

Lockwood (S.), The Pathology of Pollen in ^Estivus, or Hay- 
fever. J. N. York Micr. Soc, 1888, iv, 99-105, 1 pi. 

McBride (P.), On Hay-fever and Allied Conditions. Brit. 
M. J., Lond., 1888, ii, 605-608. 

Natier (Marcel), Fievre des foins : pathogenie et traite- 
ment. Par., 1888, 159 pp., 4to. No. 76. 

U. S. Hay -fever Association. Manual for 1888. Phila., Pa., 
1888, R. E. Lynch, 52 pp., i6mo. 

Windle (B. C. A.), A Personal Experience of Hay-fever. 
Birmingh. Med. Rev., 1888, xxiv, 259-265. 

1889. 

Bronner (A.), Pseudo-Hay -fever : Symptoms and Treat- 
ment. Lancet, Lond., 1889, ii, 66. 

Bronner (A.), Pseudo-Hay-fever. Brit. M. J., Lond., 1889, i, 
656. 



BIBLIOGRAPHY. I4I 

Hall (F. de H.), Hay-fever and Hay-asthma. Lancet, 
Lond., 1889, i, 1 183. 

Husted (N. C), Hay-fever: Its Treatment Physiologically 
and Pathologically Considered. J. N. York Micr. Soc, 
1889, v, 26-31, 1 pi. 

L. (A. H.), The Radical Cure of Hay-fever with Chromic 
Acid. Med. News, Phila., 1889, iv, 417. 

Mackenzie (Morell), Hay-fever and Paroxysmal Sneezing: 
Their Etiology and Treatment, with Appendix on Rose 
cold. 5th ed. Lond., 1889, 100 pp., 1 pi., 8vo. 

Rumbold (T. F.), Remarks Upon Pruritic Rhinitis (Hay- 
fever), and a Synopsis of Treatment. Tr. M. Ass. Mis- 
souri, St. Louis, 1889, 60-65. 

Taylor (J. J.), Hay-fever. Memphis M. Month., 1889, ix, 
486-489. 

Thornton (T. R.), Hay-fever. Kansas City Med. Index, 
1889, x, 319-323. 

1890. 

Aulde (J.), Treatment of Hay-fever. Med. and Surg. Re- 
porter, Phila., 1890, lxiii, 153-156. 

Berkart (J. B.), The Pathology of Hay-fever. Lancet, 
Lond., 1890, ii, 12, 69. 

Hurt (W. J.), Etiology and Treatment of Hay-fever. In- 
diana M. J., Indianap., 1890, 1, ix, 219. 

Rixa (A.), Contribution to the Therapeutics of Hay-fever. 
Therap. Gaz., Detroit, 1890, 3 s., vi, 311-313. 

1891. 
Bullock (J. E.), Hay-fever and Excessive Sneezing. Prov. 

M. J., Leicester, 1891, x, 324-327. 
Gluck (I.), The Treatment of an Attack of Hay-fever. 

Med. Rec, N. Y., 1891, xxxix, 564-566. 
Leal (M.), Some Observations on Hay-fever. J. Ophth., 

Otol., and Laryngol., N. Y., 1891, iii, 334-339. 



142 HAY-FEVER. 

Loebinger (H. J.), Terpine Hydrate in the Asthmatic Stage 
of Hay-fever. N. York M. J., 1891, liv, 657. 

Rixa (A.), Further Contribution to the Therapeutics of Hay- 
fever. Therap. Gaz., Detroit, 1891, 3 s., vii, 811. 

United States Hay-fever Association. Manual for 1891. 
Scientific Essays, etc. 1891, 76 pp., 8vo. 

Perkins (C. E.), Some Points on the Pathology and Treat- 
ment of Hay-fever. Cleveland M. Gaz., 1891-2, vii, 
267-273. 

1892. 

Kyle (D. B.), The Treatment of Hay-fever by Means of 
Cocaine Phenate. Med. News, Phila., 1892, lxi, 676. 

Szohner (J.), Contribution to Etiology and Treatment of 
Hay-fever. Trans. Pest. Med.-Chir. Presse, Budapest, 

1892, xxviii, 371. 

Taylor (J. I.), Hay-fever and Its Treatment. Memphis M. 

Month., 1892, xii, 7-1 1. 
Tyrrell (R. S.), A Predisposing Cause of Hay-fever. Canad. 

Pract., Toronto, 1892, xvii, 344-346. 
U. S. Hay-fever Asso. Manual for 1892. Scientific Essays, 

etc. 66 pp., i6mo. 
Williams (P. W.), Hay-fever and Hay-asthma. Bristol 

M.-Chir. J., 1892, x, 84-96. 
Macdonald (G.), A Clinical Lecture on Hay-fever and 

Asthma. Clin. J., Lond., 1892-3, i, 390-396. 

1893. 

Bishop (S. S.), A New Pathology and Treatment of Nervous 

Catarrh. J. Am. M. Ass., Chicago, 1893, xxi, 809-813. 
Treatment (The) of Hay-fever. J. Am. M. Ass., Chicago, 

1893, xxi, 798-803. (Discussion.) 

1894. 
Bishop (S. S.), A New and Successful Treatment of Hay- 
fever. The Views of the Profession. Med. News, Phila., 

1894, lxiv, 197-201. 



BIBLIOGRAPHY. I43 

Wilson (J. C), Hay-fever. American Text-book of the 
Theory and Practice of Medicine (Pepper), 1894, ii, 452. 

Wolfe (A. C.)i Treatment of Hay-fever. J. Am. M. Asso., 
Chicago, 1894, xxiii, 457-459. 

Wolfe (A. C.)i Hay-fever. Columbus M. J., 1894-5, xiii, 

3S7-397. 

1895. 

Aulde (J.), Autumnal Catarrh and Its Rational Treatment. 

Alkaloid Clinic, Chicago, 1895, ii, 171-173. 
Bicycling in Hay-fever. Med. Rec, N. Y., 1895, xlviii, 142. 
Brunson (R.), Operative Interference in Hay-fever. Hot 

Springs M. J., 1895, iv, 129-131. 
Capp (W. M.), About Local Treatment in Hay-fever. Phila. 

Polyclin., 1895, iv, 417. 
Cohen (S. S.), A Case of Hay-fever. Internat. Clinic, Phila., 

1895, 5 s., iii, 81-86. 
Prince (M.), Hay-fever, Due to Nervous Influences, Occur- 
ring in Five Members -of Same Family. Am. Gynaec. 

and Paediat., Boston, 1895, viii, 638-642. 
Smith (F. G.), Palliative Treatment of Hay-fever. Med. 

Rec, N. Y., 1895, xlviii, 484. 
Treatment of Hay-fever. Kansas M. J., Topeka, 1895, vii, 

496. 
Grayson (C. P.), The Neurotic Habit as a Causative Factor 

of Hay-fever. Univ. M. Mag., Phila., 1895-6, viii, 789- 

793- 

1896. 

Abercrombie (P. H.), Valerianate of Zinc in Hay -fever. 

Brit. M. J., Lond., 1896, i, 967. 
Amos (A. R.), Recent Views of the Causation of Asthma, 

Hay-fever, and Allied Affections, and Their Treatment. 

Tri-State Med. J., St. Louis, 1896, iii, 405-410. 
Arnold (H. A.), Hay-fever and Its Complications. Med. and 

Surg. Reporter, Phila., 1896, lxxv, 528-530. 



144 HAY-FEVER. 

Bishop (L. F.), Hay-fever and Its Successful Treatment. 
Laryngoscope, St. Louis, 1896, i, 21-28. 

Bulette (W. W.), Treatment of Hay-fever. Med. Fort- 
nightly, St. Louis, 1896, x, 476-481. 

Bulette (W. W.), Treatment of Hay-fever. Tr. Colorado 
M. Soc, Denver, 1896, 88-97. 

Cheatham (W.), Hay-fever ; The Best Treatment for Stay- 
at-homes. Laryngoscope, St. Louis, 1896, i, 225-228. 

Hunsberger (J. N.), Hay-asthma. Med. and Surg. Re- 
porter, Phila., 1896, lxxv, 777. 

McCassy (J. A. 3.), Hay-fever. Med. Progress, Louisville, 
1896, xii, 380-382. 

Sticker (G.), Der Bostock'sche Sommerkatarrh. Spec. Path, 
u. Therap., Nothnagel, Wien, 1896, iv, 2. H. 2. Abth. 
85-H5. 

Strangways (W. F.), Hay-fever: A Successful Treatment 
Founded on a New Theory. Phys. and Surg., Detroit 
and Ann Arbor, 1896, xviii, 1-8. 

Sufferer (A), Periodic Autumnal Catarrh: Hay-fever. Med. 
Age, Detroit, 1896, ii, 513-526. 

Wilson (N. L.). Uric Acid as a Factor in the Production of 
Hay-fever. N. York M. J., 1896, lxiv, 836-839. 

1897. 

Abbotts (W.), On Hay-fever, Hay-asthma, or Summer 
Catarrh. Lond., 1897, Butler & Tanner, 82 pp., i2mo. 

Capp (W. M.), A Contribution to the Symptomatology of 
Hay-fever. Med. News, N. Y., 1897, lxii, 520. 

Elias (J. P.), Bostock's Zomerkatarrh. Med. Weekbl., 
Amst., 1897-8, iv, 133-138, 149. 

Goenner (A.), Ueber Heufieber. Cor.-Bl. f. schweiz. Aerzte, 
Basel, 1897, xxvii, 233-241. 

Grayson (C. P.), The Rational Treatment of the Constitu- 
tional Factor in the Causation of Hay-fever. Therap. 
Gaz., Detroit, 1897, 3 s., xiii, 653-655. 



BIBLIOGRAPHY. 145 

Holmes (Edmund W.), Hay-fever. Med. and Surg. Rep., 

1897, xxvii, 513. 
Ingals (E. F.), Hay-fever. Twentieth Century Practice of 

Medicine, ii, 183. 
Lewis (F. D.), Hay-fever. J. Oph., Otol., and Laryngol., 

N. Y., 1897, ix, 327-332. 
Mason (A. L.), Hay-fever. Syst. Prac. M. (Loomis), N. Y. 

and Phila., 1897, ii, 178-185. 
Miiller (J.), Ueber Heufieber. Wien. med. Presse, 1897, 

1632. 
Strangways (W. F.), Hay-fever. Laryngoscope, St. Louis, 

1897, ii, 213; Phys. and Surg., Detroit and Ann Arbor, 

1897, xix, 270. 

189S. 

Cheatham (W.), This Year's Experience with the Treatment 
of Hay-fever for Stay-at-homes. Louisville Med. Monthly, 
1898-9, iv, 286. 

Clark (C. E.), A Plea for Radical Treatment of Hay-fever. 
Kansas City Med. Index, 1898, xix, 37-40. 

Goodhart (J. F.), On Asthma and Hay-fever. Syst. Medi- 
cine (Allbutt), N. Y. and Lond., 1898, v, 286-310. 

Hollopeter (W. C), Hay-fever and Its Successful Treat- 
ment. 8vo, P. Blakiston's Son & Co., Philadelphia, 1898. 

Weaver (W. H.), Hay-fever. Journal Am. Med. Assoc, 

1898, xxx, 1334-1336. 

1899. 
Dunn (J.), Uricacidemia as the Cause of Hay-fever and 

Asthma. Charlotte Med. Jour., 1899, xv, 171-177. 
Rixa (A.), Prevention of Hay-fever. J. Am. Med. Assoc, 

Chicago, 1899, xxxii, 120. 
Wright (E. W.), The Prevention of Hay-fever. N. Y. Med. 

Jour., May 6, 1899. 



INDEX 



Age, influence of, 55 
Allen, Harrison, 26, 63 
Anglo-Saxon races, frequency of 

cases in the, 47 
Areas, sensitive nasal, 62, &J 
Arnold, 1 3, 81 
Ascaris megalocephala as a 

cause, 38 
Ashhurst, Samuel, 61 
Asthma as a late symptom, 84 
diagnosis from, 94 
treatment of, 121 
Atlantic, cases on the, 50 
Australia, cases in, 49 



Bacteriologic study of nasal 

secretions, 103 
Bastian, 38 
Beard, G. M., 25, 33, 34, 48, 

51, 52, 54,56,57,72,79,88, 

94, 9S 
Beecher, Henry Ward, cases in 

the family of, 53 
Benzoic acid, as a cause, 36 
Beschorner, 18 
Bibliography, 127 
Binz, C, 22 

Bishop, S. S., 27, 64, 65, 66 
Blackley, Chas. H., 13, 24, 35, 

55 



Blackley, experiments of, 40 
Blossoming dates, mutability of, 

45 
Bostock, J., 19, 30 
Bosworth, 51, 53, 59, 63, 64 

73, 74, 76, 85, 91, 94, 99 
Botallus, 18 
Broussais, 39 
Bullette, W. M., 52, 100 



Canada, cases in, 50 
Capp, W. M. , 67, 90 
Cardiac involvement, 86 
Caterpillars as a cause, ^8 
Causes, exciting, 30 
predisposing, 47 
Cavernous tissue, nasal, 92 
Chaveau, 48 
Chills, analogv to recurrence of, 

74 
Chocolate as a cause, 37 
Cinders as an exciting cause, 34 
Clark, Sir Andrew, 27 
Cleansing of the nares, 115 
Cocain, 113 
Coffee as a cause, 2>7 
Complications, 84 
Conklin, 65 
Cornaz, 21 

Coryza, diagnosis from, 95 
Cottonwood fever, 5 1 
Cough as a symptom, 82 



147 



148 



INDEX. 



Cough, persistent, between par- 
oxysms, 84 

Cullen, 37 

Cutaneous eruptions as compli- 
cations, 85 



Daly, W. H., 26, 62 

Darwin, 45 

Definition, 10 

Denmark, cases in, 49 

Diagnosis, 94 

Diatheses, theory, 16 

Diet, 120 

Discharges, nasal, 82 

Drenger, 39 

Duration, 76 

Dust as a cause, 19, 34 

Dysphagia as a symptom, 82 



E 

Ebstein, 65 

Elliotson, 18, 20 

Emanations from dry hay as a 

cause, 19 
England, distribution of cases 

in, 49 
Erectile tissues, nasal, 92 
Eucain, 113 
Exciting causes, 30 
Experiments of Blackley on the 

pollen theory, 40 
Eye-symptoms, 81 



Fatigue as a cause, 19 
Feathers as a cause, 37 
Fever during an attack, 8^ 
Floyer, 18 
France, cases in, 49 
French, rarity of cases among 
the, 48 



Fruit as a cause, 37 

Fungoid growth as a cause, 14 



Gaslight, influence of, 22 

Gastro-intestinal causes, 70 

General remarks, 12 

Genito-urinary organs, involve- 
ment of, 8^ 

Germans, rarity of cases among 
the, 48 

Germany, cases in, 49 

Gibbons, 99 

Grasses, varieties of, causative, 

43 
Grayson, C. P. , 28, 68 
Gream, G. Y., 20 

H 

Hack, W., 26, 60, 62 
Haig, 64 

" Hair-caterpillar asthma," ^8 
Handkerchiefs, effluvia from, as 

a cause, 37 
Hare, odor of, as a cause, 1,8 
Heart, involvement of, 86 
Heat as a cause, 19, 30 
Helmholtz, 14, 22, 36 
Heredity, influence of, 52 
Herzog, 62 
Holmes, E. W., 35,45 , 47, 55, 

56, 61, 63, 68, 80, 91, 94 
Horses, odor of, as a cause, 38 
H iiners wolff, 39 
Hygienic treatment, 116 

I 

Idiosyncrasy, influence of, 60 
Imagination, influence of, 39, 74 
India, cases in, 49 
Indian, case in an, 48 
Indigestion as a cause, 69 



INDEX. 



149 



Ingals, 33 

Insomnia as a symptom, 82 
Insurance, effect on, 98 
Intermittent fever, analogy to, 

74 
Ipecac as a cause, 37 
Italy, cases in, 49 
Itzigson, 37 
Ivy-poisoning, analogy to, 44 



Jacobi, 48 
Kinnear, 59 



K 



Labosse, 21 

Laforgue, 20 

Life insurance, effect on, 98 

mode of, influence of, 56 
Light as a cause, 32 
Linseed meal as a cause, 37 
Local disease theory, 17, 62 

treatment, 107 
Locust-tree blossoms as a cause, 

37 
Longevity, effect on, 98 
Lycopodium as a cause, 37 

M 
MacCulloch, 20 

Macdonald, 28, 49, 79, 99 
Mackenzie, J. N., 26, 39, 48, 59, 

62, 63, 74, 88 
Mackenzie, Morell, 27, 33, 39, 

40, S3, 54,5Mo, 76,87,117 
Males, prevalence in, 54 
Mango-tree as a cause, 44 
Marsh, E. J., 25,44 
Mattress as a cause, 39 
May apple as a cause, 37 
Mays, Thomas J., 65 
Micro-organisms in the nasal 

discharges, 22 



Moore, George, 23 
Mucous membrane, nasal, 93 
Mulberry blossoms as a cause, 37 
Muller, J., 70 
Murchison, 65 
Murrell, William, 37, 38 
Mustard as a cause, 37 
Mutability of blossoming dates, 
45 

N 
Name, origin of, 19 
Nasal abnormalities as causes, 12 

symptoms, 81 
Negro, case in a, 48 
Nervous supply to the nares, 89 
Nettle-rash as a complication, 84 
Neurasthenic cases, 1 17 
Neurotic element, 15 

theory, 57 
New Zealand, cases in, 49 
Norway, cases in, 49 
Nose, coldness of, 79 
Nutrition, defective, a cause, 6S 



Oak as a cause, 3J 
Obstruction of the nares as a 

cause, 63 
Occupation, influence of, 56 
Occurrence, time of, 72 
Ocean, cases on the, 44 
Odors of fruits and flowers as 

causes, 39 
Onset, symptoms of, 81 
Origin of the name, 19 
Ozone as a cause, 35 



Parry, C. L., 18 

Pathology, 87 

Peaches, odor of, as a cause, 39 

Periodicity, 80 

Phoebus, P., 20, 31, 32, 35, 54, 

74 



ISO 



INDEX. 



Pirne, W., 22, 31, 33,49 
Pneumonia as a complication, 

86 
Podophyllum as a cause, 3J 
Pollen, first reference to, 13 
kinds of, 42 
theory, 40 
Polypi, Bosworth's views rela- 
tive to, 63 
Prater, Augustus, 20 
Predisposing causes, 47 
Premonitory symptoms, 78 
Prince, M., 54, 59, 74, 75 
Proctor, Richard, case of, 32 
Prognosis, 98 

Prophylactic treatment, 116 
Protoplasmic substance as a 

cause, 15 
Pruritus ani during an attack, 

83 

Psychic influence in the causa- 
tion, 39, 74 
Pulse during an attack, 8^ 



Quinin solution as a remedy, 
Quinquaud, 65 



Race, influence of, 47 
Rag-weed as an exciting cause, 

43 

Ramadge, 20 

Rectum, involvement of, 8^ 

Recurrence, period of, 72 

Regions of the nasal cavities, 87 

Riedlin, 18 

Ringer, 38 

Roberts, W. C. , 23, 79 

Robinson, B., 60 

Roe, J. O., 26, 62, 90 

Roman wormwood as an ex- 
citing cause, 53 

Russia, cases in, 49 



S 

Sajous, C. E. de M., 26, 48, 

53, 62, 78, 90 
Salter, Hyde, 21,38 
Scotland, cases in, 49 
Sea, cases at, 44 
Sensitive areas of the nares, 62, 

87 

Sequelae, 84 

Serum, nasal, 88 

Sex, influence of, 54 

Smell, involvement of, 86 

Smith, Ward, 37 

Smith, W. A., 22, 44, 47, 50 

Sneezing in, 81, 95 

Solis-Cohen, J., 59 

Solis-Cohen, S., 60 

South America, cases in, 49 

Spain, cases in, 49 

Spontaneous disappearance of 

the recurrences, 100 
Sterilization of the nares, 115 
Strangways, W. F., 14 
Sunlight, influence of, ^^ 
Sunshine as a cause, 19 
Suprarenal extract, 1 14 
Surgical treatment, 1 14 
Swallowing, difficult, 82 
Sweden, cases in, 49 
Symptoms, y8 
Synonyms, 9 
Systemic treatment, 116 

T 

Taste, involvement of, 86 
Tea-drinking, influence of, 48 
Temperature during an attack, 

8 3 

Theory, idiosyncrasy, 60 

local, 17, 62 

neurotic, 57 

pollen, 40 

uric-acid, 64 
Thornwaldt, 64 
Timaeus, 18 



INDEX. 



151 



Time of occurrence, 72 
Tomatoes as a cause, 37 
Toxin as a cause, 13 
Treatment, 102 

preliminary local, 106 

prophylactic, hygienic, and 
systemic, 116 

surgical, 114 
Trosseau, 39 
Types, 78 

according to duration, 77 



U 

United States, distribution of 

cases in the, 50 
Uric-acid theory, 64 



Van Helmont, 18 
Vasomotor control, nasal, 88 

susceptibility, theory of, 59 
Vibrios in the discharges, 22 
Vogel,36 
Voice, changes in, S^ 

W 

Walshe, 21, 44, 50 
Watermelons as a cause, 37 
Watson, 21 

Sir Thomas, ^ 
White Mountains, immunity in, 

51 

Wilson, J. C. , 44 
Wyman, Morrill, 23, 48, 50, 51, 
53,54,55 



HUMPHREY'S 

MANUAL OF NURSING. 

MEDICAL AND SURGICAL. 



A complete Text-Book for Nurses, including General Anatomy 
and Physiology, Management of the Sick-Room, Appliances used 
in Sick-Room, Antiseptic Treatment, Bandaging, Cooking for 
Invalids, etc., etc. 

Sixteenth Edition. With 79 Illustrations. 

BY LAWRENCE HUMPHREY, M.A., M.D. 

12MO. CLOTH. PRICE $1.00. 



St. Joseph's Hospital, 

Seventeenth and Girard Avenue, 

Philadelphia, March 15, 1893. 
Messrs. P. Blakhton, Son <Sr» Co. .•— 

Please send us six more copies of Manual of Nursing, by Humphrey. We 
do not know of any book that more completely meets the requirements of a 
Training Class than Dr. Humphrey's able Lectures, for they are at once clear, 
concise, and thoroughly practical. Sisters of Charity. 



From British Medical Journal, London. 

11 Nursing literature is expanding, and, what is more to the purpose, it shows 
manifold signs of Improvement with its growth. In the fullest sense, Dr. 
Humphrey's book is a distinct advance on all previous manuals. It is, in point 
of fact, a concise treatise on medicine and surgery for the beginner, incorporat- 
ing with the text the management of childbed and the hygiene of the sick-room. 
Its value is greatly enhanced by copious wood-cuts and diagrams of the bones 
and internal organs, by many illustrations of the art of bandaging, by tempera- 
ture charts indicative of the course of some of the most characteristic diseases, 
and by a goodly array of sick-room appliances, with which every nurse should 

endeavor to become acquainted The systematic arrangement :>f 

subjects adopted by the author is excellent." 



THE BEST GENERAL TEXT-BOOK. 



BOOKS ON MASSAGE. 



Massage and the Original Swedish Move- 
ments. Illustrated. And Their Application to 
Various Diseases of the Body. A Manual for Students, 
Nurses, and Physicians. By Kurre W. Ostrom, 
from the Royal University of Upsala, Sweden ; 
formerly Instructor in Massage and Swedish Move- 
ments in the Hospital of the University of Pennsyl- 
vania and in the Philadelphia Polyclinic and College 
for Graduates in Medicine, etc. Illustrated by 105 
explanatory Wood Engravings. Fourth Edition, Re- 
vised and Enlarged. 121110. 168 pages. Cloth, $1.00 

" Mr. Ostrom presents to the English public this excellent, systematic manual, 
showing, by illustrations, the various movements and the mode of application to 
all parts of the body. The writer tells for what diseases such movements are 
indicated, with some remarks on the physiology of the movement treatment." 
—From The Philadelphia Public Ledger. 

u In this volume the author gives an excellent description of the methods of 
massage and Swedish movement, together with their applicability to various 
diseased conditions of the body. The methods are rapidly becoming popular- 
ized in our own country, and the perusal of such a book as Mr. Ostrom has 
written will be of great advantage to physicians, for whose use it is mainly in- 
tended." — From the Journal of the American Medical Association. 

WARD, Notes on Massage; Including Ele- 
mentary Anatomy and Physiology. By Jessie 
M. Ward, Instructor in Massage in the Pennsylvania, 
Philadelphia, Jefferson, and Woman's Hospitals; 
Clinical Lecturer at Philadelphia Polyclinic. i2mo. 
Interleaved. Paper cover, $1. 00 



SURGICAL NURSING. 

BY BERTHA M. VOSWINKEL, 

Graduate of the Episcopal Hospital, Philadelphia ; late Nurse-in- Charge of 
Children' s Hospital, Columbus, O. 

INCLUDING COMPLETE CHAPTERS ON 

BANDAGING, DRESSINGS, 

SPLINTS, ETC. 

SECOND EDITION-ENLARGED. JUST READY. 

112 Illustrations. i2mo. 206 Pages. Cloth, $1.00. 



Synopsis of Contents. — I. Introductory Remarks, Care of 
Patient, Beds, etc. — II. Qualifications of Surgical Nurse — III. Anti- 
septics and Antiseptic Surgery — IV. An- 
tiseptic Dressings — V and VI. Gynecol- 
ogic Nursing — VII and VIII. Hemor- 
rhages — IX. Wounds and their Com- 
plications — X. Fractures, Dislocations, 
Sprains — XI. Nursing in Special Cases 
— XII. Bandaging — XIII. Fixed Dress- 
ings — XIV. Splints and Braces — XV. 
Massage — Appendix A. Invalid Cookery 
— Appendix B. Enemas, Ice Poultice, 
Excessive Perspiration, Weights and 
Measures, Bichlorid Table, Poisons — 
Appendix C. Preparation of Patient for 
Transfusion, Normal Salt Solution, 
Preparation of Rubber Tissue, Kronig's Method of Sterilizing 
Catgut — Index. 

From The Chicago Medical Recorder. 

"The book is eminently practical and concise. The author's style and 
methods are excellent." 




So. mp le II lu stration from. 

VoswinkeV s Surgical 

Nursing. 



THE 



American Health Primers. 

EDITED BY W. W. KEEN, M.D., 

Professor of Surgery in the Jefferson Medical College, Fellow of the College 
of Physicians of Philadelphia, etc. 



12 Vols. 32mo. Attractive Cloth Binding, each 40 Cents. 

This Series of Health Primers is prepared to diffuse as widely and 
cheaply as possible, among all classes, a knowledge of the elementary facts of 
Preventive Medicine. They are intended incidentally to assist in curing dis- 
eases, and to teach people how to form correct habits of living, and take care 
of themselves, their children, employees, etc. 

I. HEARING AND HOW TO KEEP IT. With Illustrations. By Chas. 

H. Burnett, m.d., of Philadelphia, Aurist to the Presbyterian Hospital. 

II. LONG LIFE AND HOW TO REACH IT. By J. G. Richardson, m.d., 
of Philadelphia, late Professor of Hygiene in the University of Pennsyl- 
vania. 

III. THE SUMMER AND ITS DISEASES. By James C. Wilson, m.d., 
of Philadelphia, Professor of the Practice of Medicine, Jefferson Medical 
College. 

IV. EYESIGHT AND HOW TO CARE FOR IT. With Illustrations. By 
George C. Harlan, m.d., of Philadelphia, Surgeon to the Wills (Eye) 
Hospital. 

V. THE THROAT AND THE VOICE. With Illustrations. By J. Solis 
Cohen, m.d., of Philadelphia, Lecturer on Diseases of the Throat in Jef- 
ferson Medical College, and on the Voice in the National School of Oratory. 

VI. THE WINTER AND ITS DANGERS. By Hamilton Osgood, m.d., 
of Boston, Editorial Staff Boston Medical and Surgical Journal. 

VII. THE MOUTH AND THE TEETH. With Illustrations. By J. W. 
White, m.d., d.d.s., of Philadelphia, Editor of the Dental Cosmos. 

VIII. BRAIN WORK AND OVERWORK. By H. C. Wood, Jr., m.d., of 
, Philadelphia, Clinical Professor of Nervous Diseases in the University of 

* Pennsylvania. 

IX. OUR HOMES. With Illustrations. By Henry Hartshorne, m.d., 
of Philadelphia, formerly Professor of Hygiene in the University of Penn- 
sylvania. 

X. THE SKIN IN HEALTH AND DISEASE. With Illustrations. By 
L. D. Bulkley, m.d., of New York, Physician to the Skin Department 
of the New York Hospital. 

XI. SEA AIR AND SEA BATHING. With Illustrations. By John H. 
Packard, m.d., of Philadelphia, Surgeon to the Pennsylvania Hospital. 

XII. SCHOOL AND INDUSTRIAL HYGIENE. By D. F. Lincoln, m.d., 

of Boston, Mass., Chairman Department of Health, American Social 
Science Association. 

" The series of 'American Health Primers ' deserves hearty commendation. 
These handbooks of practical suggestions are prepared by men whose profes- 
sional competence is beyond question, and, for the most part, by those who 
have made the subject treated the study of their lives." — New York Sun. 

*** Each Volume 40 Cents, in Attractive Cloth Binding. 



FIFTH EDITION 

ACCIDENTS and EMERGENCIES. 

A Manual for the treatment of Surgical and other Injuries, 
Poisoning and various Medical Emergencies, in the absence of the 
Physician. 

By CHARLES W. DULLES, M.D.,. 

Surgeon to the Rush Hospital ; formerly Surgeon to the Out-Door Depart- 
vieyits of the University and Presbyterian Hospitals , Philadelphia. 



Fifth Edition, Enlarged. 



New Illustrations. 12mo. 
ILLUSTRATED. 



Cloth, $1.00 



SHORT LIST OF CONTENTS. 



Preliminary Remarks. 
Obstructions to Respiration. 
Foreign Bodies in the Eye, Nose and 

Ear. 
Fits or Seizures. 
Injuries to the Brain. 
Effects of Heat and Cold. 
Electricity, Accidents caused by. 
Sprains. 
Dislocations. 
Fractures. 
Wounds of all kinds, including the 

bites of Dogs, Cats, Snakes, Insects, 

etc. 
Railroad and Machinery Accidents. 



Hemorrhage — Bleeding. 

Special Hemorrhages. 

Transportation of the Injured. 

Poisons and their Antidotes. 

Domestic Emergencies, includes Chol- 
era Morbus, Vomiting, Diarrhoea, 
Nervous Attacks, Earache, Tooth- 
ache, Asthmatic Attacks, Croup, 
etc., etc. 

Signs of Death. 

Supplies for Emergencies. 

The Surgical and Medicine Case, 
their contents and use, Bandaging, 
Poultices, etc. 

Index. 



*#* This book should be in the possession of every head of a 
family, Nurse, Manufacturer, Police Lieutenant, Sea Captain, Hos- 
pital Steward, School Teacher, Druggist, etc. etc. 

" Several attempts have been made to prepare a volume which would serve 
as a handy manual for reference in the time of need, in the absence of a doctor, 
but none have succeeded better than the present little work. It should be in the 
hands of all officers charged with the public conveyance of passengers, to be 
read, in preparation for emergencies, and afterward to serve as a book of refer- 
ence." — North Carolina Medical J our 71 al. 

" This little manual contains simple directions for the preliminary treatment 
of accidents to all parts of the body and of such diseases as persons are suddenly 
seized with. Without profuseness or an unintelligible vocabulary, it contains in 
a small space a deal of useful information." — New York World. 

" This is a revised and enlarged edition, with new illustrations, of the manual, 
explaining the treatment of surgical and other injuries in the absence of the phy- 
sician. The simple and practical suggestions of this little book should be known 
to every one. Accidents are constantly occurring, and a knowledge of what 
should be done in an emergency is very valuable. Such a handbook should be 
in every home, placed where it can always be found readily. — Boston Journal 
of Education. 



THE 

Hygiene of the Nursery, 

INCLUDING THE GENERAL REGIMEN AND FEEDING OF INFANTS 

AND CHILDREN AND THE DOMESTIC MANAGEMENT 

OF THE ORDINARY EMERGENCIES OF 

EARLY LIFE. 

BY LOUIS STARR, M.D., 

Clinical Professor of Diseases of Children in the Hospital of the University 
of Pennsylvania; Physician to the Children's Hospital, Phila. 

Sixth Edition. Enlarged and improved. 

WITH TWENTY-FIVE ILLUSTRATIONS. 

i2mo. 280 Pages. Cloth, $1.00. 



*h* This book contains very complete directions for the proper 
feeding of infants : 1st, From the maternal breast. 2d. By wet- 
nurse, including rules for choosing the woman. 3d, Artificial 
Feeding. This part of the subject is elaborated carefully, so as to 
include everything of importance, and will be found of great service 
to the monthly nurse. General and specific rules for feeding are 
given, and Diet Lists from the first week up to the eighteenth 
month, w T ith various recipes for artificial foods, peptonized milk, etc. 
Directions for the sterilization of milk, substitutes for milk, prepara- 
tion of food for both well and sick children, nutritious enemata. 
etc., and the general management of the Nursery. 

" Dr. Starr's experience as Clinical Professor of Diseases of Children in the 
University Hospital and as physician to the Children's Hospital, with his 
eminence in private practice among juvenile patients, is ample warranty for the 
satisfaction and instruction to be found in this book. The dedication " To my 
Little Patients," shows the sympathy with which the writer enters upon the 
important discussion. The volume is entirely in the modern lines of preventive 
medicine — more important in the nursery than at any other time of life ; because 
constitution building is going on then and there. In this admirable treatise, so 
clearly written that no mother need be deterred by fear of medical terms from 
making its teaching her own, Dr. Starr carries out the highest ideal of the 
modern physician, so to regulate the lives of his professional clients that the 
occasions are less frequent when he need be called in to act for serious compli- 
cations. * * * * With the numerous good treatises on the subject that 
Philadelphia publications include, this intelligent work is the most distinguished, 
as it is also the latest work on complete Hygiene of the Nursery." — The Led- 
ger, Philadelphia. 



A HANDBOOK OF 

MATERIA MEDICA 

Including- Sections on Therapeutics and Toxicology, and 

a very complete Glossary of Terms with 

Dose and use of each Drug*. 



SPECIALLY PREPARED FOR TRAINED NURSES. 



BY JOHN E. GROFF, Ph.G., 

Apothecary in the Rhode Island Hospital, Providence. 



235 PAGES. 12M0. HANDSOMELY BOUND IN CLOTH, $1.25. 



*3j* In preparing this work the author has endeavored to present 
the extensive subject of Materia Medica in a systematic form, suffi- 
ciently comprehensive to meet the requirements of the trained nurse. 

The work is intended to make the nurse acquainted with the 
numerous drugs of vegetable and chemic origin, their Latin and 
English names, the parts of the plants used, the names of and some- 
thing about the preparations, the chemicals used as medicines, the 
handling of them, etc. A set of questions follow each chapter, and 
there are many explanatory foot-notes and paragraphs. 

From the Medical Record, New York. 

" It will undoubtedly prove a valuable aid to the nurse in securing a knowl- 
edge of drugs and their uses." 

From Philadelphia Medical Journal. 

" The task of abridging the subject of materia medica for the use of trained 
nurses is far from an easy one, as it is necessary to use good judgment in 
putting in what it would be well and helpful for her to know without leaving out 
the necessary part. Moreover, to arrange the subject in a practical and sys- 
tematic manner for the purpose of teaching and ready reference is a difficult 
matter. The author of this book has succeeded admirably in doing this, and 
the work is sure to be in great demand by nurses." 



A NEW EDITION, JUST READY. 

GOULD'S POCKET MEDICAL LEXICON. 



21,000 MEDICAL WORDS 

PRONOUNCED AND DEFINED. 

A Pronouncing Lexicon of Medical "Words Specially Adapted for 
Nurses, Including Many Useful Tables and a Dose List. 



BY GEORGE M. GOULD, M.D.. 

Author of "An Illustrated Dictionary of Medi- 
cine , Biology , and Allied Sciences," "The 
Student's Medical Dictionary," etc. 

Pocket Size. 522 Pages. Gilt Edges, 

Full Morocco. Price $1.00; with 

a Thumb Index, $1.25. 




OVER 90,000 COPIES OF GOULD'S 

DICTIONARIES HAVE BEEN SOLD. 



" Gould's Dictionary, Pocket Edition, is the most complete and convenient I 
have seen." — Marion E. Smith, Head Nurse, Philadelphia Hospital, Phila. 

" The Pocket Dictionary is a little gem." — L. J. Gross, Head Nurse , Bujfalo 
General Hospital. 

" I have examined Gould's Dictionary, and consider it the best dictionary in 
a small compass that I have seen. The price, too, is most reasonable I shall 
recommend it to all our nurses." — F. Hutcheso7i, Head Nurse, Flower Mission 
Training School for Nurses, Indianapolis , bid. 

" 1 shall certainly have the nurses each send for a copy of the dictionary. It 
is just what they need, and is a nice size to carry." — Harriet Sutherland, Head 
Nurse, Margaret Pillsbury Hospital, Concord, N. H. 



&g=* Every nurse should have a copy of this little book in order 
to intelligently pursue her studies and to thoroughly understand 
the physician's directions. It furnishes a vast amount of informa- 
tion not to be obtained in the regular text-books. 



Catalogue No. 8. June, 1899. 

CLASSIFIED SUBJECT 
CATALOGUE 

OF 

MEDICAL BOOKS 

AND 

Books on Medicine, Dentistry, Pharmacy, 
Chemistry, Hygiene, Etc., Etc., 

PUBLISHED BY 

P. Blakistons Son & Co., 

Medical Publishers and Booksellers, 

1012 WALNUT STREET, PHILADELPHIA. 



SPECIAL NOTE. — The prices given in this catalogue are 
absolutely net, no discount will be allowed retail purchasers 
under any consideration. This rule has been established in 
order that everyone will be treated alike, a general reduction 
in former prices having been made to meet previous retail dis- 
counts. Upon receipt of the advertised price any book will 
be forwarded by mail or express, all charges prepaid. 



We keep a large stock of Miscellaneous Books, not on this 
catalogue, relating to Medicine and Allied Sciences, pub- 
lished in this country and abroad. Inquiries in regard to 
prices, date of edition, etc., will receive prompt attention. 

Special Catalogues of Books on Pharmacy, Dentistry, 
Chemistry, Hygiene, and Nursing will be sent free upon 
application. 

J^-SEE NEXT PAGE FOR SUBJECT INDEX. 



Gould's Dictionaries, Page 8. 



SUBJECT INDEX. 



4&~ Any books not on this Catalogue we will furnish a price 
for upon application. 



SUBJECT PAGE 

Alimentary Canal (see Surgeiy) 19 
Anatomy (see Miscellaneous).. 14 

Anesthetics 3 

Autopsies (see Pathology) 16 

Bacteriology (see Pathology) 16 

Bandaging (see Surgery) 19 

Brain 4 

Chemistry 4 

Children, Diseases of 6 

Clinical Charts 6 

Compends 22, 23 

Consumption (see Lungs) 11 

Dentistry 7 

Diagnosis 17 

Diagrams (see Anatomy, page 
3, and Obstetrics, page 16). 

Dictionaries . 8 

Diet and Food (see Miscella- 
neous) 14 

Dissectors 3 

Domestic Medicine 10 

Ear 8 

Electricity 9 

Emergencies (see Surgery) 19 

Eye 9 

Fevers 9 

Gout .... 10 

Gynecology 21 

Hay Fever 20 

Heart 10 

Histology 10 

Hospitals (see Hygiene) 11 

Hygiene 11 

Insanity 4 

Latin, Medical (see Miscella- 
neous and Pharmacy) 14, 16 

Lungs 12 

Massage 12 

Materia Medica 12 

Medical Jurisprudence 13 

Microscopy 13 

M ilk Analy sis (see Chemistry) 4 

Miscellaneous 14 

Nervous Diseases 14 



SUBJECT. PAGE 

Nose 20 

Nursing 15 

Obstetrics 16 

Ophthalmology 9 

Osteology (see Anatomy) 3 

Pathology 16 

Pharmacy 16 

Physical Diagnosis 17 

Physical Training (see Miscel- 
laneous) 14 

Physiology 18 

Poisons (see Toxicology) 13 

Popular Medicine 10 

Practice of Medicine 18 

Prescription Books 18 

Railroad Injuries (see Nervous 

Diseases) 14 

Refraction (see Eye) 9 

Rheumatism 10 

Sanitary Science 11 

Skin 19 

Spectacles (see Eye) 9 

Spine (see Nervous Diseases) 14 
Stomach (see Miscellaneous)... 14 

Students' Compends 22, 23 

Surgery and Surgical Dis- 
eases 19 

Syphilis 21 

Technological Books 4 

Temperature Charts 6 

Therapeutics 12 

Throat 20 

Toxicology ■ 13 

Tumors (see Surgery) 19 

U S. Pharmacopoeia 16 

Urinary Organs 20 

Urine 20 

Venereal Diseases 21 

Veterinary Medicine 21 

Visiting Lists, Physicians'. 

{Send for Special Circular.) 
Water Analysis (see Chemis- 
try) 4 

Women, Diseases ot 21 



' The prices as given in this Catalogue are net. Cloth 
binding, unless otherwise specified. No discount can be 
allowed under any circumstances. Any book will be sent, 
postpaid, upon receipt of advertised price. 



SUBJECT CATALOGUE OF MEDICAL BOOKS. 3 

J$&~ All books are bound in cloth, unless otherwise speci- 
fied. All prices are net. 

ANATOMY. 

MORRIS. Text-Book ot Anatomy. 2d Edition. Revised and 
Enlarged. 790 Illustrations, 214 of which are printed in coiors. 
Just Ready. Cloth, $6.00; Leather, $7.00 ; Half Russia, $8.00 

" Taken as a whole, we have no hesitation in according very high 
praise to this work. It will rank, we believe, with the leading Anato- 
mies. The illustrations are handsome and the printing is good." — 
Boston Medical and Surgical Journal. 

Handsome Circular of Morris, with sample pages and colored illus- 
trations, will be sent free to any address. 

BROOMELL. Anatomy and Histology of the Human Mouth 
and Teeth. 284 Illustrations. #4 50 

DEAVER. Surgical Anatomy. A Treatise on Human Anatomy 
in its Application to Medicine and Surgery. With about 400 very 
Handsome full-page Illustrations Engraved from Original Drawings 
made by special Artists from dissections prepared for the purpose. 
Three Volumes. Royal Square Octavo 
Cloth, $2 . co ; Half Morocco or Sheep, $24 00; Half Russia, $27.00 

ECKLEY. Practical Anatomy. A Manual for the use of Students 
in the Dissecting Room. 1 ased upon Morris' Text-Book of Anatomy. 
With over 20J Illustrations. Nearly Ready. 

GORDINIER. Anatomy of the Central Nervous System. 
With many Illustrations, the majority of which are original. 
Just Ready. Cloth, $6.00; Sheep, $7 00 

HEATH. Practical Anatomy. 8th Edition. 300 Illus. $4.25 

HOLDEN. Anatomy. A Manual of the Dissections of the Human 
Body. Carefully Revised by A. Hewson, m.d., Demonstrator of 
Anatomy, Jefferson Medical College, Philadelphia. 311 Illustrations. 
7th Edition. In Press. 

HOLDEN. Human Osteology. Comprising a Description of the 
Bones, with Colored Delineations of the Attachments of the Muscles. 
The General and Microscopical Structure of Bone and its Develop- 
ment. With Lithographic Plates and numerous Illus. 8th Ed. $5.25 

HOLDEN. Landmarks. Medical and Surgical. 4th Ed. $1 00 

MACALISTER. Human Anatomy. Systematic and Topograph- 
ical, including the Embryology, Histology, and Morphology of Man. 
With Special Reference to the Requirements of Practical Surgery and 
Medicine. 816 Illustrations. Cloth, $5.00; Leather, #6.00 

MARSHALL. Physiological Diagrams. Life Size, Colored. 
Eleven Life-Size Diagrams (each seven feet by three feet seven 
inches). Designed for Demonstration before the Class. 

In Sheets, Unmounted, $40.00 ; Backed with Muslin and Mounted 
on Rollers, $60.00; Ditto, Spring Rollers, in Handsome Walnut Wall 
Map Case, $100.00; Single Plates — Sheets. $5.00; Mounted, $7.50. 
Explanatory Key, .50. Descriptive circular upon application. 

POTTER. Compend of Anatomy, Including Visceral Anatomy. 

6th Ed. 16 Lith. Plates and 117 other Illus. .80; Interleaved, $1.25 
WILSON. Human Anatomy, nth Edition. 429 Illustrations, 26 

Colored Plates, and a Glossary of Terms. $5.00 

WINDLE. Surface Anatomy and Landmarks. Colored and 

other Illustrations. $1.00 



SUBJECT CATALOGUE 



BRAIN AND INSANITY. 

BLACKBURN. A Manual of Autopsies. Designed for the Use 
of Hospitals for the Insane and other Public Institutions. Ten full- 
page Plates and other Illustrations. $1.25 

GORDINIER. The Gross and Minute Anatomy of the Central 
Nervous System. With many full-page and other Illustrations. 
8vo. Just Ready. Cloth, $6.00 ; Sheep, $7.00 

GO WERS. Diagnosis of Diseases of the Brain. 2d Edition. 
Illustrated. $*-5o 

HORSLEY. The Brain and Spinal Cord. The Structure and 
Functions of. Numerous Illustrations. $ 2 -5o 

LEWIS (BEVAN). Mental Diseases. A Text Book Having 
Special Reference to the Pathological Aspects of Insanity- 26 Litho- 
graphic Plates and other Illustrations. 2d Ed. Just Ready. $7.00 

MANN. Manual of Psychological Medicine and Allied 
Nervous Diseases. Their Diagnosis, Pathology, Prognosis, and 
Treatment, including their Medico- Legal Aspects ; with chapter on 
Expert Testimony, and an Abstract of the Laws Relating to the 
Insane in all the States of the Union. Illustrated. $3.00 

REGIS. Mental Medicine. Authorized Translation by H. M. 
Bannister, m.d. $2.00 

STEARNS. Mental Diseases. Designed especially for Medical 
Students and General Practitioners. With a Digest of Laws of the 
various States Relating to Care of Insane. Illustrated. 

Cloth, $2.75; Sheep, $3.25 

TUKE. Dictionary of Psychological Medicine. Giving the 
Definition, Etymology, and Symptoms of the Terms used in Medical 
Psychology, with the Symptoms, Pathology, and Treatment of the 
Recognized Forms of Mental Disorders, together with the Law of 
Lunacy in Great Britain and Ireland. Two volumes. #10.00 

WOOD, H. C. Brain and Overwork. .40 

CHEMISTRY AND TECHNOLOGY. 

Special Catalogue of Chemical Books sent free upon application. 
ALLEN. Commercial Organic Analysis. A Treatise on the 

Modes of Assaying the Various Organic Chemicals and Products 

Employed in the Arts, Manufactures, Medicine, etc., with concise 

methods for the Detection of Impurities, Adulterations, etc. 8vo. 

Vol. I. Alcohols, Neutral Alcoholic Derivatives, etc., Ethers, Veg- 
etable Acids, Starch, Sugars, etc. 3d Edition, by Henry Leff- 
mann, M. d. fust Ready. * #4-5o 

Vol. II, Part I. Fixed Oils and Fats, Glycerol, Explosives, etc. 
3d Edition, by Henry Leffmann, m. d. Just Ready. $350 

Vol. II, Part II. Hydrocarbons, Mineral Oils, Phenols, etc. 3d 
Edition, by Henry Leffmann, m.d. Nearly Ready. 

Vol. Ill, Part I. Acid Derivatives of Phenols, Aromatic Acids, 
Tannins, Dyes and Coloring Matters. 3d Edition. In Preparation. 

Vol. Ill, Part II. The Amines, Hydrazines and Derivatives, 
Pyridine Bases. The Antipyretics, etc. Vegetable Alkaloids, Tea, 
Coffee, Cocoa, etc. 8vo. 2d Edition. $4 .50 

Vol. Ill, Part III. Vegetable Alkaloids, Non-Basic Vegetable Bitter 
Principles. Animal Bases, Animal Acids, Cyanogen Compounds, 
etc. 2d Edition, 8vo. #4-5° 

Vol. IV. The Proteids and Albuminous Principles. 2d Edition. 
Just Ready. $4- 5° 

Appendix Volume. Containing a Review of the whole work with 
many new methods, etc. In Preparation. 



MEDICAL BOOKS. 



ALLEN. Chemical Analysis of Albuminous and Diabetic 

Urine. Illustrated. $225 

BARTLEY. Medical and Pharmaceutical Chemistry. A 

Text-Book for Medical, Dental, and Pharmaceutical Students. With 
Illustrations. Glossary, and Complete Index. 5th Edition, carefully 
Revised. Just Ready. Cloth, £3.00 ; Sheep, $3.50 

BARTLEY. Clinical Chemistry. The Examination of Feces, 
Saliva, Gastric Juice, Milk, and Urine. Just Ready. $1.00 

BLOXAM. Chemistry, Inorganic and Organic. With Experi- 
ments. 8th Ed., Revised 281 Engravings Clo.,$4.25; Lea., $5.25 

CALDWELL. Elements of Qualitative and Quantitative 
Chemical Analysis. 3d Edition, Revised. $i-5° 

CAMERON. Oils and Varnishes. With Illustrations. $2.25 

CAMERON. Soap and Candles. 54 Illustrations. $2.00 

GARDNER. The Brewer, Distiller, and Wine Manufac- 
turer. Illustrated. $i-5o 

GARDNER. Bleaching, Dyeing, and Calico Printing. $1.50 

GROVES AND THORP. Chemical Technology. The Appli- 
cation of Chemistry to the Arts and Manufactures. 
Vol. I. Fuel and Its Applications. 607 Illustrations and 4 Plates. 
Cloth, $5.00; Half Morocco, $6.50 
Vol.11. Lighting. Illustrated. Cloth, $4. 00; Half Morocco, $5.50 
Vol. III. Lighting — Continued. In Press. 

HOLLAND. The Urine, the Gastric Contents, the Common 
Poisons, and the Milk. Memoranda, Chemical and Microscopi- 
cal, for Laboratory Use. 5th Ed Illustrated and interleaved, $1.00 

LEFFMANN. Compend of Medical Chemistry, Inorganic 
and Organic. Including Urine Analysis. 4th Edition, Rewritten 
and Revised. .80; Interleaved, $1.25 

LEFFMANN. Analysis of Milk and Milk Products. Arranged 
to Suit the Needs of Analytical Chemists, Dairymen, and Milk Inspec- 
tors. 2d Edition. Enlarged, Illustrated. $1 .25 

LEFFMANN. Water Analysis. Illustrated. 4th Edition. $1.25 

LEFFMANN. Structural Formulae. Including 180 Structural 
and Stereo-Chemical Formulae. i2mo. Interleaved. $1.00 

MUTER. Practical and Analytical Chemistry. 2d American 
from the Eighth English Edition. Revised to meet the requirements 
ol American Medical Colleges by Claude C. Hamilton, m.d. 56 
Illustrations, fust Ready. $i-z$ 

OETTEL. Exercises in Electro-Chemistry. Illustrated. .75 

OETTEL. Electro-Chemical Experiments. Illustrated. .75 

RICHTER. Inorganic Chemistry. 4th American, from 6th Ger- 
man Edition. Authorized translation by Edgar F. Smith, m.a., 
ph.d. 89 Illustrations and a Colored Plate. $i-75 

RICHTER. Organic Chemistry. 3d American Edition. Trans, 
from the 8th German by Edgar F. Smith. Illustrated. 2 Volumes. 
Vol. I. Aliphatic Series. 625 Pages. Just Ready. $3.00 

Vol.11. Aromatic Series. In Preparation. 

SMITH. Electro-Chemical Analysis. 2d Edition, Revised. 28 
Illustrations. $1 25 

SMITH AND KELLER. Experiments. Arranged for Students 
in General Chemistry. 3d Edition. Illustrated. .60 

STAMMER. Chemical Problems. With Answers. 50 



SUBJECT CATALOGUE. 



SUTTON. Volumetric Analysis. A Systematic Handbook for 
the Quantitative Estimation of Chemical Substances by Measure, 
Applied to Liquids, Solids, and Gases. 7th Edition, Revised. 112 
Illustrations. $4.50 

SYMONDS. Manual of Chemistry, for Medical Students. 
2d Edition. $2.00 

TRAUBE. Physico-Chemical Methods. Translated by Hardin. 
97 Illustrations. Just Ready. $1.50 

ULZER AND FRAENKEL. Chemical Technical Analysis. 
Translated by Fleck. Illustrated. Just Ready. $1.25 

WOODY. Essentials of Chemistry and Urinalysis. 4th 
Edition. Illustrated. In Press. 

*** Special Catalogue of Books on Chemistry free upon application . 



CHILDREN. 

CAUTLIE. Feeding of Infants and Young Children by Nat- 
ural and Artificial Methods. $2.00 
HALE. On the Management of Children. .50 

HATFIELD. Compend of Diseases of Children. With a 
Colored Plate. 2d Edition. .80; Interleaved, $1. 25 

MEIGS. Infant Feeding and Milk Analysis. The Examination 
of Human and Cow's Milk, Cream, Condensed Milk, etc., and 
Directions as to the Diet of Young Infants. .50 

POWER. Surgical Diseases of Children and their Treat- 
ment by Modern Methods. Illustrated. $2.50 

STARR. The Digestive Organs in Childhood. The Diseases of 

the Digestive Organs in Infancy and Childhood. With Chapters on 
the Investigation of Disease and the Management of Children. 2d 
Edition, Enlarged. Illustrated by two Colored Plates and numerous 
Wood Engravings. $2.00 

STARR. Hygiene of the Nursery. Including the General Regi- 
men and Feeding of Infants and Children, and the Domestic Manage- 
ment of the Ordinary Emergencies of Early Life, Massage, etc. 6th 
Edition. 25 Illustrations. $1.00 

TAYLOR AND WELLS. The Diseases of Children. Illus- 
trated. A New Manual. 746 pages. Just Ready. $4.00 



CLINICAL CHARTS. 

GRIFFITH. Graphic Clinical Chart for Recording Temper- 
ature, Respiration, Pulse, Day of Disease, Date, Age, Sex, 
Occupation, Name, etc. Printed in three colors. Sample copies 
free. Put up in loose packages of fifty, .50. Price to Hospitals, 500 
copies, $4.00 ; 1000 copies, $7.50. With name of Hospital printed 
on, .50 extra. 

KEEN'S CLINICAL CHARTS. Seven Outline Drawings of the 
Body, on which may be marked the Course of Disease, Fractures, 
Operations, etc. Pads of fifty, £i.co. Each Drawing may also be 
had separately, twenty-five to pad, 25 cents. 



MEDICAL BOOKS. 



SCHREINER. Diet Lists. Arranged in the form of a chart. 
With Pamphlets of Specimen Dietaries. Pads of 50. .75 

DENTISTRY. 

Special Catalogue of Dental Books sent free upon application. 

BARRETT. Dental Surgery for General Practitioners and 
Students of Medicine and Dentistry. Extraction of Teeth, 
etc. 3d Edition. Illustrated. Nearly Ready. 

BLODGETT. Dental Pathology. By Albert N. Blodgktt, 
m.d., late Professor of Pathology and Therapeutics, Boston Dental 
College. 33 Illustrations. $ I - 2 S 

BROOMELL. Anatomy and Histology of the Human Mouth 
and Teeth. 284 Handsome Illustrations. Just Ready. $4-50 

FLAGG. Plastics and Plastic Filling, as Pertaining to the Filling 
of Cavities in Teeth of all Grades of Structure. 4th Edition. $4.00 

FILLEBROWN. A Text-Book of Operative Dentistry. 

Written by invitation of the National Association of Dental Facul- 
ties. Illustrated. $2.25 
GORGAS. Dental Medicine. A Manual of Materia Medica and 
Therapeutics. 6th Edition, Revised. Cloth, $4.00; Sheep, $5.00 

HARRIS. Principles and Practice of Dentistry. Including 
Anatomy, Physiology, Pathology, Therapeutics, Dental Surgery, 
and Mechanism. 13th Edition. Revised by F. J. S. Gorgas, m.d., 
d.d.s. 1250 Illustrations. Cloth, $6.00; Leather, $7.00 

HARRIS. Dictionary of Dentistry. Including Definitions of Such 
Words and Phrases of the Collateral Sciences as Pertain to the Art and 
Practice of Dentistry. 6th Edition. Revised and Enlarged by Fer- 
dinand F. S. Gorgas, m d., d.d.5. Cloth, $5.00; Leather, $6.00 

HEATH. Injuries and Diseases of the Jaws. 4th Edition 187 

Illustrations. #4-5o 

HEATH. Lecture^ on Certain Diseases of the Jaws. 64 

Illustrations. Boards, .50 

RICHARDSON. Mechanical Dentistry. 7th Edition. Thor- 
oughly Revised and Enlarged by Dr. Geo. W. Warren. 691 Illus- 
trations. Cloth, $5.00; Leather, $6.00 

SEWELL. Dental Surgery. Including Special Anatomy and 
Surgery. 3d Edition, with 200 Illustrations. $2.00 

SMITH. Dental Metallurgy. Illustrated. $1.75 

TAFT. Index of Dental Periodical Literature. £2.00 

TALBOT. Irregularities of the Teeth and Their Treatment. 

2d Edition. 234 Illustrations. ^3.00 

TOMES. Dental Anatomy. Human and Comparative. 263 Illus- 
trations. 5th Edition. Just Ready. $4.00 
TOMES. Dental Surgery. 4th Edition. 289 Illustrations. #4.00 
WARREN. Compend of Dental Pathology and Dental Medi- 
cine. With a Chapter on Emergencies. 3d Edition. Illustrated. 
Just Ready. .80; Interleaved, $1.25 

WARREN. Dental Prosthesis and Metallurgy. 129 Ills. $1.25 
WHITE. The Mouth and Teeth. Illustrated. .40 

*** Special Catalogue of Dental Books free upon application. 



SUBJECT CATALOOUF. 



DICTIONARIES. 

GOULD. The Illustrated Dictionary of Medicine, Biology, 
and Allied Sciences. Being an Exhaustive Lexicon of Medicine 
and those Sciences Collateral to it: Biology (Zoology and Botany), 
Chemistry, Dentistry, Parmacology, Microscopy, etc., with many 
useful Tables and numerous fine Illustrations. 1633 pages. 4th Ed. 
Sheep or Half Dark Green Leather, $10.00; Thumb Index, $11.00 
Half Russia, Thumb Index, $12.00 

GOULD. The Medical Student's Dictionary. Including all the 
Words and Phrases Generally Used in Medicine, with their Proper 
Pronunciation and Definition, Based on Recent Medical Literature. 
With Tables of the Bacilli, Micrococci, Mineral Springs, etc., of the 
Arteries, Muscles, Nerves, Ganglia, and Plexuses, etc. 10th Edition. 
Rewritten and Enlarged. Completely reset from new type. 700 pp. 
Hall Dark Leather, $3.25 ; Half Morocco, Thumb Index, $4.00 

GOULD. The Pocket Pronouncing Medical Lexicon. (21,000 
Medical Words Pronounced and Defined.) Containing all the Words, 
their Definition and Pronunciation, that the Medical, Dental, or 
Pharmaceutical Student Generally Comes in Contact With; also 
Elaborate Tables of the Arteries, Muscles, Nerves, Bacilli, etc., etc., 
a Dose List in both English and Metric System, etc., Arranged in a 
Most Convenient Form for Reference and Memorizing. A new Edi- 
tion, enlarged by 200 pages. Just Ready. 

Full Limp Leather, Gilt Edges, $i.on ; Thumb Index, $1.25 
90,000 Copies of Gould's Dictionaries Have Been Sold. 
*** Sample Pages and Illustrations and Descriptive Circulars of 

Gould's Dictionaries sent free upon application. 

HARRIS. Dictionary of Dentistry. Including Definitions of Such 
Words and Phrases of the Collateral Sciences as Pertain to the Art 
and Practice of Dentistry. 6th Edition. Revised and Enlarged by 
Ferdinand J. S. Gorgas, m.d., d.d.s. Cloth, $5.00; Leather, $6 00 

LONGLEY. Pocket Medical Dictionary. With an Appendix, 
containing Poisons and their Antidotes, Abbreviations used in Pre- 
scriptions, etc. Cloth, .75; Tucks and Pocket, $1.00 

MAXWELL. Terminologia Medica Polyglotta. By Dr. 
Theodore Maxwell, Assisted by Others. $3.00 

The object of. this work is to assist the medical men ot any nationality 

in reading medical literature written in a language not their own. 

Each term is usually given in seven languages, viz. : English, French, 

German, Italian, Spanish, Russian, and Latin. 

TREVES AND LANG. German-English Medical Dictionary. 

Half Russia, $3.25 

EAR (see also Throat and Nose). 

BURNETT. Hearing and How to Keep It. Illustrated .40 

DALBY. Diseases and Injuries of the Ear. 4th Edition. 38 
Wood Engravings and 8 Colored Plates. $2.50 

HOVELL. Diseases of the Ear and Naso-Pharynx. Includ- 
ing Anatomy and Physiology of ihe Organ, together with the Treat- 
ment of the Affections of the Nose and Pharynx which Conduce to 
Aural Disease. 122 Illustrations. 2d Edition. Preparing. 

PRITCHARD. Diseases of the Ear. 3d Edition, Enlarged. 
Many Illustrations and Formulae $i-5° 

WOAKES. Deafness, Giddiness, and Noises in the Head. 
4th Edition. Illustrated. $2.00 



MEDICAL BOOKS. 



ELECTRICITY. 

BIGELOW. Plain Talks on Medical Electricity and Bat- 
teries. With a Therapeutic Index and a Glossary. 43 Illustra- 
tions. 2d Edition. $1.00 

JONES. Medical Electricity. 3d Edition. 112 Illus. In Press. 

MASON. Electricity ; Its Medical and Surgical Uses. Numer- 
ous Illustrations. .75 

EYE. 

A Special Circular of Books on the Eye sent free upon application. 

ARLT. Diseases of the Eye. Clinical Studies on Diseases of the 
Eye. Translation by Lyman Ware. m.d. Illustrated. $1-25 

DONDERS. The Nature and Consequences of Anomalies of 
Refraction. With Portrait and other Illustrations. 8vo. 

Just Ready. Half Morocco, $1.25 

FICK. Diseases of the Eye and Ophthalmoscopy. Trans- 
lated by A. B. Hale, m. d. 157 Illustrations, many of which are in 
colors, and a glossary. Cloth, $4.50 ; Sheep, #5.50 

GOULD AND PYLE. Compend of Diseases of the Eye and 
Refraction. Including Treatment and Operations, and a Section 
on Local Therapeutics. With Formulae, Useful Tables, a Glossary, 
and in Illustrations, several of which are in colors. 

Cloth, .80; Interleaved, $1.25 

GOWERS. Medical Ophthalmoscopy. A Manual and Atlas 
with Colored Autotype and Lithographic Plates and Wood-cuts, 
Comprising Original Illustrations of the Changes of the Eye in Dis- 
eases of the Brain, Kidney, etc. 3d Edition. $4.00 

HARLAN. Eyesight, and How to Care for It. Illus. .40 

HARTRIDGE. Refraction. 104 Illustrations and Test Types. 
9th Edition, Enlarged. Just Ready. $1.50 

HARTRIDGE. On the Ophthalmoscope. 3d Edition. With 
4 Colored Plates and 68 Wood-cuts. $!-5o 

HANSELL AND REBER. Muscular Anomalies of the Eye. 
Illustrated. Just Ready. $1.50 

HANSELL AND BELL. Clinical Ophthalmology. Colored 
Plate of Normal Fundus and 120 Illustrations. #1.50 

JESSOP. Manual of Ophthalmic Surgery and Medicine. Col- 
ored Plates and 108 other Illustrations. Just Ready. Cloth, $3 00 

MORTON. Refraction of the Eye. Its Diagnosis and the Cor- 
rection of its Errors. With Chapter on Keratoscopy and Test 
Types. 6th Edition. $1.00 

OHLEMANN. Ocular Therapeutics. Authorized Translation, 
and Edited by Dr. Charles A. Oliver. Just Ready. #!-75 

PHILLIPS. Spectacles and Eyeglasses. Their Prescription 
and Adjustment. 2d Edition. 49 Illustrations. #1.00 

SWANZY. Diseases of the Eye and Their Treatment. 6th 

Edition, Revised and Enlarged. 158 Illustrations, 1 Plain Plate, 
and a Zephyr Test Card. $3.00 

THORINGTON. Retinoscopy. 3d Edition. Illustrated. $1.00 

'WALKER. Students' Aid in Ophthalmology. Colored Plate 
and 40 other Illustrations and Glossary. $ 1 5o 



10 SUBJECT CATALOGUE. 

FEVERS. 

COLLIE. On Fevers. Their History, Etiology, Diagnosis, Prog- 
nosis, and Treatment. Colored Plates. $2.00 

GOODALL AND WASHBOURN. Fevers and Their Treat- 
ment. Illustrated. #3.00 

GOUT AND RHEUMATISM. 

DUCKWORTH. A Treatise on Gout. With Chromo-lithographs 
and Engravings. Cloth, $6.00 

GARROD. On Rheumatism. A Treatise on Rheumatism and 
Rheumatic Arthritis. Cloth, $5.00 

HAIG. Causation of Disease by Uric Acid. A Contribution to 
the Pathology of High Arterial Tension, Headache, Epilepsy, Gout, 
Rheumatism, Diabetes, Bright's Disease, etc. 4th Edition. $3.00 

HEALTH AND DOMESTIC MEDI- 
CINE (see also Hygiene and Nursing). 

BUCKLEY. The Skin in Health and Disease. Illus. ,40 

BURNETT. Hearing and How to Keep It. Illustrated. .40 

COHEN. The Throat and Voice. Illustrated. .40 

DULLES. Emergencies. 4th Edition. Illustrated. $1.00 
HARLAN. Eyesight and How to Care for It. Illustrated. .40 

HARTSHORNE. Our Homes. Illustrated. .40 

OSGOOD. The Winter and its Dangers. .40 

PACKARD. Sea Air and Bathing. .40 

PARKES. The Elements of Health. $1.25 

RICHARDSON. Long Life and How to Reach It. .40 

WESTLAND. The Wife and Mother. $1.50 

WHITE. The Mouth and Teeth. Illustrated. .40 

WILSON. The Summer and its Diseases. .40 

WOOD. Brain Work and Overwork. .40 

STARR. Hygiene of the Nursery. 5th Edition. £1.00 

CANFIELD. Hygiene of the Sick-Room. $1.25 

. HEART. 

SANSOM. Diseases of the Heart. The Diagnosis and Pathology 
of Diseases of the Heart and Thoracic Aorta. With Plates and other 
Illustrations. $6.00 

HISTOLOGY. 

STIRLING. Outlines of Practical Histology. 368 Illustrations. 
2d Edition, Revised and Enlarged. With new Illustrations. $2.00 

STOHR. Histology and Microscopical Anatomy. Translated 
and Edited by A. Schaper, m.d., Harvard Medical School. Second 
Edition, Revised and Enlarged. 292 Illustrations. $3.00 



MEDICAL BOOKS. 



HYGIENE AND WATER ANALYSIS. 

Special Catalogue of Books on Hygiene sent free upon application. 

CANFIELD. Hygiene of the Sick-Room. A Book for Nurses 
and Others. Being a Brief Consideration of Asepsis, Antisepsis, Dis- 
infection, Bacteriology, Immunity, Heating, Ventilation, etc. $1.25 

COPLIN AND BEVAN. Practical Hygiene. A Complete 
American Text-Book. 138 Illustrations. New Ed. Preparing. 

KENWOOD. Public Health Laboratory Work. 116 Illustra- 
tions and 3 Plates. $2.00 

LEFFMANN. Examination of Water for Sanitary and 
Technical Purposes. 4th Edition. Illustrated. $ J -25 

LEFFMANN. Analysis of Milk and Milk Products. Illus- 
trated. $ x -25 

LINCOLN. School and Industrial Hygiene. .40 

MACDONALD. Microscopical Examinations of Water and 
Air. 25 Lithographic Plates, Reference Tables, etc. 2d Ed. $2.50 

McNEILL. The Prevention of Epidemics and the Construc- 
tion and Management of Isolation Hospitals. Numerous Plans 
and Illustrations. $3-5o 

NOTTER AND FIRTH. The Theory and Practice of Hygiene. 
(Being the 9th Edition of Parkes' Practical Hygiene, rewritten and 
brought up to date.) 10 Plates and 135 other Illustrations. 1034 
pages. 8vo. $7.00 

PARKES. Hygiene and Public Health. By Louis C. Parkes, 
m.d. 5th Edition. Enlarged. Illustrated. $2.50 

PARKES. Popular Hygiene. The Elements of Health. A Book 
for Lay Readers. Illustrated. #1.25 

STARR. The Hygiene of the Nursery. Including the General 
Regimen and Feeding of Infants and Children, and the Domestic 
Management of the Ordinary Emergencies of Early Life, Massage, 
etc. 6th Edition. 25 Illustrations. $1.00 

STEVENSON AND MURPHY. A Treatise on Hygiene. By 
Various Authors. In Three Octave Volumes. Illustrated. 

Vol. I, $6.00; Vol. II, $6.00; Vol. Ill, $5.00 
*** Each Volume sold separately. Special Circular upon application. 

WILSON. Hand-Book of Hygiene and Sanitary Science. 

Wiih Illustrations. 8th Edition. $300 

WEYL. Sanitary Relations of the Coal-Tar Colors. Author- 
ized Translation by Henry Leffmann, m.d., ph.d. $1.25 
*** Special Catalogue of Books on Hygiene free upon application. 

LUNGS AND PLEURA. 

HARRIS AND BEALE. Treatment of Pulmonary Consump- 
tion. $2.50 

KNOPF. Pulmonary Tuberculosis. Its Modern Prophylaxis. 
Illustrated. Nearly Ready. 

POWELL. Diseases of the Lungs and Pleurae, including 

Consumption. Colored Plates and other Illus. 4th Ed. $4.00 

TUSSEY. High Altitudes injthe Treatment of Consumption. 

I1.50 



12 SUBJECT CATALOGUE. 

MASSAGE. 

KLEEN. Hand-Book of Massage. Authorized translation by 
Mussey Hartwell, m.d., PH.D. With an Introduction by Dr. S. 
Weir Mitchell. Illustrated by a series of Photographs Made 
Especially by Dr. Kleen for the American Edition. $2.25 

MURRELL. Massotherapeutics. Massage as a Mode of Treat- 
ment. 6th Edition. In Press. 

OSTROM. Massage and the Original Swedish Move- 
ments. Their Application to Various Diseases of the Body A 
Manual for Students, Nurses, and Physicians. Fourth Edition, En- 
larged. 105 Wood Engravings, many of which are original $1.00 

WARD. Notes on Massage. Interleaved. Paper cover, $1. 00 

MATERIA MEDICA AND THERA- 
PEUTICS. 

ALLEN, HARLAN, HARTE, VAN HARLINGEN. A 
Hand-Book of Local Therapeutics, Beinga Practical Description 
of all those Agents Used in the Local Treatment of Diseases of the 
Eye, Ear, Nose and Throat, Mouth, Skin, Vagina, Rectum, etc., 
such as Ointments, Plasters, Powders, Lotions, Inhalations, Supposi- 
tories, Bougies, Tampons, and the Proper Methods of Preparing and 
Applying Them. Cloth, $3.00 ; Sheep, $4.00 

BIDDLE. Materia Medica and Therapeutics. Including Dose 
List, Dietary for the Sick, Table of Parasites, and Memoranda of 
New Remedies. 13th Edition, Thoroughly Revised in accord- 
ance with the new U. S. P. 64 Illustrations and a Clinical Index. 

Cloth, $4.00; Sheep, $5.00 
BRACKEN. Outlines of Materia Medica and Pharmacology. $2.75 
COBLENTZ. The Newer Remedies. 3d Edition, Enlarged and 
Revised. Nearly Ready. 

DAVIS. Materia Medica and Prescription Writing. %\ 50 
FIELD. Evacuant Medication. Cathartics and Emetics. $1.75 
GORGAS. Dental Medicine. A Manual of Materia Medica and 
Therapeutics. 6th Edition, Revised. $4.00 

GROFF. Materia Medica for Nurses. Just Ready. $1.25 

HELLER. Essentials of Materia Medica, Pharmacy, and 
Prescription Writing. $1.50 

MAYS. Theine in the Treatment of Neuralgia. % bound, .50 
NAPHEYS. Modern Therapeutics, gth Revised Edition, En- 
larged and Improved. In two handsome volumes. Edited by Allen 
J. Smith, m.d., and J. Aubrey Davis, m.d. 

Vol. I. General Medicine and Diseases of Children. $4.00 

Vol. II. General Surgery, Obstetrics, and Diseases of Women. £4.00 

POTTER. Hand-Book of Materia Medica, Pharmacy, and 
Therapeutics, including the Action of Medicines, Special Therapeu- 
tics, Pharmacology, etc., including over 600 Prescriptions and For- 
mulae. 7th Edition, Revised and Enlarged. With Thumb Index in 
each copy, fust Ready. Cloth, $5.00; Sheep, $6.co 

POTTER. Compend of Materia Medica, Therapeutics, and 
Prescription Writing, with Special Reference to the Physiologi- 
cal Action of Drugs. 6th Revised and Improved Edition, based upon 
the U. S. P. 1890. .80; Interleaved, $1.25 



MEDICAL BOOKS. 13 



SAYRE. Organic Materia Medica and Pharmacognosy. An 

Introduction to the Study of the Vegetable Kingdom and the Vege- 
table and Animal Drugs. Comprising the Botanical and Physical 
Characteristics, Source, Constituents, and Pharmacopeial Prepara- 
tions. With chapters on Synthetic Organic Remedies, Insects In- 
jurious to Drugs, and Pharmacal Botany. A Glossary and 543 Illus- 
trations, many of which are original. 2d Edition. Preparing. 

WARING. Practical Therapeutics. 4th Edition, Revised and 
Rearranged. Cloth, $2.00; Leather, $3.00 

WHITE AND WILCOX. Materia Medica, Pharmacy, Phar- 
macology, and Therapeutics. 4th American Edition, Revised by 
Reynold W. Wilcox, m.a., m.d., ll.d. Clo., $3.00; Lea., $3.50 



MEDICAL JURISPRUDENCE AND 
TOXICOLOGY. 

REESE. Medical Jurisprudence and Toxicology. A Text-Book 
for Medical and Legal Practitioners and Students. 5th Edition. 
Revised by Henry Leffmann, m.d. Clo., $3.00; Leather, $3. 50 

" To the student of medical jurisprudence and toxicology it is in- 
valuable, as it is concise, clear, and thorough in every respect." — The 
American Journal of the Medical Sciences. 

MANN. Forensic Medicine and Toxicology. Illus. $6.50 

MURRELL. What to Do in Cases of Poisoning. 8th 

Edition, Enlarged. #1.00 

TANNER. Memoranda of Poisons. Their Antidotes and Tests. 
7th Edition. .75 

MICROSCOPY. 

BEALE. The Use of the Microscope in Practical Medicine. 

For Students and Practitioners, with Full Directions for Examining the 
Various Secretions, etc., by the Microscope. 4th Ed. 500 Illus. $6.50 

BEALE. How to Work with the Microscope. A Complete 
Manual of Microscopical Manipulation, containing a Full Description 
of many New Processes of Investigation, with Directions for Examin- 
ing Objects Under the Highest Powers, and for Taking Photographs 
of Microscopic Objects. 5th Edition. 400 Illustrations, many of 
them colored. #6.50 

CARPENTER. The Microscope and Its Revelations. 8th 

Edition. 800 Illustrations and many Lithographs. Preparing. 

LEE. The Microtomist's Vade Mecum. A Hand-Book of 

Methods of Microscopical Anatomy. 887 Articles. 4th Edition, 

Enlarged. #4.00 

MACDONALD. Microscopical Examinations of Water and Air. 
25 Lithographic Plates, Reference Tables, etc. 2d Edition. $2.50 

REEVES. Medical Microscopy, including Chapters on Bacteri- 
ology, Neoplasms, Urinary Examination, etc. Numerous Illus- 
trations, some of which are printed in colors. $2.50 

WETHERED. Medical Microscopy. A Guide to the Use of the 
Microscope in Practical Medicine. 100 Illustrations. $2.00 



14 SUBJECT CATALOGUE. 

MISCELLANEOUS. 

BLACK. Micro-Organisms. The Formation of Poisons. A 
Biological Study of the Germ Theory of Disease. .75 

BURNETT. Foods and Dietaries. A Manual of Clinical Diet- 
etics. 2d Edition. $150 
BUXTON. Anaesthetics. Illustrated. 3d Edition. In Press. 
GOULD. Borderland Studies. Miscellaneous Addresses and 
Essays. i2mo. $2.00 
GOWERS. The Dynamics of Life. .75 
HAIG. Causation of Disease by Uric Acid. A Contribution to 
the Pathology of High Arterial Tension, Headache, Epilepsy, Gout, 
Rheumatism, Diabetes, Bright's Disease, etc. 4th Edition. $3.00 
HAIG. Diet and Food. Considered in Relation to Strength and 
Power of Endurance. Just Ready. $1.00 
HARE. Mediastinal Disease. Illustrated by six Plates. $2.00 
HEMMETER. Diseases of the Stomach. Their Special Path- 
ology, Diagnosis, and Treatment. With Sections on Anatomy, Diet- 
etics, Surgery, etc. Illustrated. Clo. $6.00; Sh. $7.00 
HENRY. A Practical Treatise on Anemia. Half Cloth, .50 
LEFFMANN. The Coal-Tar Colors. With Special Reference to 
their Injurious Qualities and the Restrictions of their Use. A Trans- 
lation of Theodore Weyl's Monograph. $1-25 
MARSHALL. History of Woman's Medical College of Penn- 
sylvania. $1.50 
NEW SYDENHAM SOCIETY'S PUBLICATIONS. Circulars 
upon application. Per Annum, $8.00 
TREVES. Physical Education : Its Effects, Methods, Etc. .75 
LIZARS. The Use and Abuse of Tobacco. .40 
PARRISH. Alcoholic Inebriety. $1.00 
ST. CLAIR. Medical Latin. $1.00 
SCHREINER. Diet Lists. Pads of 50. .75 
TURNBULL. Artificial Anaesthesia. 4th Edition. Illus. $2.50 

NERVOUS DISEASES. 

BEEVOR. Diseases of the Nervous System and their Treat- 
ment. £2.50 

GORDINIER. The Gross and Minute Anatomy of the Cen- 
tral Nervous System. With many original Colored and other 
Illustrations. Just Ready. Cloth, $6.00; Sheep, $7.00 

GOWERS. Manual of Diseases of the Nervous System. A 
Complete Text-Book. Revised, Enlarged, and in many parts Re- 
written. With many new Illustrations. Two volumes. 
Vol. I. Diseases of the Nerves and Spinal Cord. 3d Edition, En- 
larged. Cloth, $4.00; Sheep, $5.00 
Vol. II. Diseases of the Brain and Cranial Nerves ; General and 
Functional Disease. 2d Edition. Cloth, $4.00; Sheep, $5.00 

GOWERS. Syphilis and the Nervous System. $1.00 

GOWERS. Diagnosis of Diseases of the Brain. 2d Edition. 
Illustrated. $i-5o 

GOWERS. Clinical Lectures. A New Volume of Essays on the 
Diagnosis, Treatment, etc., of Diseases of the Nervous System. $2.00 

GOWERS. Epilepsy and Other Chronic Convulsive Diseases. 
2d Edition. In Press. 



MEDICAL BOOKS. 15 



HORSLEY. The Brain and Spinal Cord. The Structure and 
Functions of. Numerous Illustrations. $2.50 

ORMEROD. Diseases of the Nervous System. 66 Wood En- 
gravings. $1.00 

OSLER. Cerebral Palsies of Children. A Clinical Study. $2.00 

OSLER. Chorea and Choreiform Affections. $2.00 

PRESTON. Hysteria and Certain Allied Conditions. Their 
Nature and Treatment. Illustrated. $2.00 

WATSON. Concussions. An Experimental Study of Lesions Aris- 
ing from Severe Concussions. Paper cover, $1.00 

WOOD. Brain Work and Overwork. .40 

NURSING. 

Special Catalogue of Books for Nurses sent free upon application. 
BROWN. Elementary Physiology for Nurses. .75 

CANFIELD. Hygiene of the Sick-Room. A Book for Nurses and 
Others. Being a Brief Consideration of Asepsis, Antisepsis, Disinfec- 
tion, Bacteriology, Immunity, Heating and Ventilation, and Kindred 
Subjects for the Use of Nurses and Other Intelligent Women. #1.25 

CULLINGWORTH. A Manual of Nursing, Medical and Sur- 
gical. 3d Edition with Illustrations. .75 

CULLINGWORTH. A Manual for Monthly Nurses. 3d Ed. .40 

CUFF. Lectures to Nurses on Medicine. New Ed. $1.25 

DOMVILLE. Manual for Nurses and Others Engaged in At- 
tending the Sick. 8th Edition. With Recipes for Sick-room Cook- 
ery, etc. .75 

FULLERTON, Obstetric Nursing. 41 Ills. 5th Ed. $1.00 

FULLERTON. Nursing in Abdominal Surgery and Diseases 
of Women. Comprising the Regular Course of Instruction at the 
Training-School of the Women's Hospital, Philadelphia. 2d Edition. 
70 Illustrations. $1.50 

GROFF. Materia Medica for Nurses. With Questions for Self-Ex- 
amination and a very complete Glossary. Just Ready. $1-25 

HUMPHREY. A Manual for Nurses. Including General 
Anatomy and Physiology, Management of the Sick Room, etc. 
16th Ed. Illustrated. $1.00 

SHAWE. Notes for Visiting Nurses, and all those Interested 
in the Working and Organization of District, Visiting, or 
Parochial Nurse Societies. With an Appendix Explaining the 
Organization and Working of Various Visiting and District Nurse So- 
cieties, by Helen C. Jenks, of Philadelphia. $1.00 

STARR. The Hygiene of the Nursery. Including the General 
Regimen and Feeding of Infants and Children, and the Domestic Man- 
agement of the Ordinary Emergencies of Early Life, Massage, etc. 6th 
Edition. 25 Illustrations. $1.00 

TEMPERATURE AND CLINICAL CHARTS. See page 6. 
VOSWINKEL. Surgical Nursing. Second Edition, Enlarged. 
112 Illustrations. Just Ready. $1.00 

WARD. Notes on Massage. Interleaved. Paper cover, $1.00 

OBSTETRICS. 

BAR. Antiseptic Midwifery. The Principles of Antiseptic Meth- 
ods Applied to Obstetric Practice. Authorized Translation by 
Henry D. Fry, m.d., with an Appendix by the Author. $1.00 



16 SUBJECT CATALOGUE. 

CAZEAUX AND TARNIER. Midwifery. With Appendix by 
Mundb. The Theory and Practice of Obstetrics, including the Dis- 
eases of Pregnancy and Parturition, Obstetrical Operations, etc. 
8th Edition. Illustrated by Chromo-Lithographs, Lithographs, and 
other full-page Plates, seven of which are beautifully colored, and 
numerous Wood Engravings Cloth, $4.50 ; Full Leather, $5.50 

DAVIS. A Manual of Obstetrics. Being a Complete Manual tor 
Physicians and Students. 3d Enlarged and Revised Edition. With 
Colored and many other Illustrations. In Press 

LANDIS. Compend of Obstetrics. 6th Edition, Revised by Wm. 
H. Wells, Assistant Demonstrator of Clinical Obstetrics, Jefferson 
Medical College. With 47 Illustrations, .80; Interleaved, $1.25. 

SCHULTZE. Obstetrical Diagrams. Being a series of 20 Col- 
ored Lithograph Charts, Imperial Map Size, of Pregnancy and Mid- 
wifery, with accompanying explanatory (German) text illustrated 
by Wood Cuts. 2d Revised Edition. 

Price in Sheets, £26.00 ; Mounted on Rollers, Muslin Backs, £36.00 

STRAHAN. Extra-Uterine Pregnancy. The Diagnosis and 
Treatment of Extra-Uterine Pregnancy. 75 

WINCKEL. Text-Book of Obstetrics, Including the Pathol- 
ogy and Therapeutics of the Puerperal State. Authorized 
Translation by J. Clifton Edgar, a.m., m.d. With nearly 200 Illus- 
trations. Cloth, £5.00; Leather, $6.00 

FULLERTON. Obstetric Nursing. 5th Ed. Illustrated. £1.00 

PATHOLOGY. 

BARLOW. General Pathology. 795 pages. 8vo. $5.00 

BLACKBURN. Autopsies. A Manual of Autopsies Designed for 
the Use of Hospitals for the Insane and other Public Institutions. 
Ten full-page Plates and other Illustrations. $1-25 

BLODGETT. Dental Pathology. By Albert N. Blodgett, 
m.d., late Professor of Pathology and Therapeutics, Boston Dental 
College. 33 Illustrations. $1.25 

COPLIN. Manual of Pathology. Including Bacteriology, Technic 
of Post-Mortems, Methods of Pathologic Research, etc. 265 Illus- 
trations, many of which are original. i2mo. $3.00 

GILLIAM. Pathology. A Hand-Book for Students. 47 Illus. .75 

HALL. Compend of General Pathology and Morbid Anatomy. 
91 very fine Illustrations. 2d Edition. .80 : Interleaved, $1.25 

HEWLETT. Manual of Bacteriology. 75 Illustrations. $3.00 

VIRCHOW. Post-Mortem Examinations. A Description and 
Explanation of the Method of Performing Them in the Dead House 
of the Berlin Charity Hospital, with Special Reference to Medico- 
Leg^al Practice. 3d Edition, with Additions. .75 

WHITACRE. Laboratory Text-Book of Pathology. With 
121 Illustrations. $1 .50 

WILLIAMS. Bacteriology. A Manual for Students. 78 Illus- 
trations. Just Ready. $1.50 

PHARMACY. 

Special Catalogue of Books on Pharmacy sent free upon application. 

COBLENTZ. The Newer Remedies. Including their Synonyms, 
Sources, Methods of Preparation, Tests, Solubilities, and Doses as 
far as known. Together with Sections on the Organo-Therapeutic 
Agents and Indifferent Compounds of Iron. Third Edition, very 
much Enlarged. Just Ready. $1.00 

COBLENTZ. Manual of Pharmacy. A New and Complete 
Text-Book by the Professor in the New York College of Pharmacy. 
2d Edition, Revised and Enlarged. 437 Illus. Cloth, $3.50 ; Sh., $4.50 



MEDICAL BOOKS. 17 



BEASLEY. Book of 3100 Prescriptions. Collected from the 
Practice of the Most Eminent Physicians and Surgeons — English, 
French, and American. A Compendious History of the Materia 
Medica, Lists of the Doses of all the Officinal and Established Pre- 
parations, an Index of Diseases and their Remedies. 7th Ed. $2.00 

BEASLEY. Druggists' General Receipt Book. Comprising 
a Copious Veterinary Formulary, Recipes in Patent and Proprietary 
Medicines, Druggists' Nostrums, etc. ; Perfumery and Cosmetics, 
Beverages, Dietetic Articles and Condiments, Trade Chemicals, 
Scientific Processes, and many Useful Tables. 10th Ed. $2.00 

BEASLEY. Pharmaceutical Formulary. A Synopsis of the 
British, French, German, and United States Pharmacopoeias. Com- 
prising Standard and Approved Formulae for the Preparations and 
Compounds Employed in Medicine. T2th Edition. Just Ready. $2.00 

PROCTOR. Practical Pharmacy. Lectures on Practical Phar- 
macy. With Wood Engravings and 32 Lithographic Fac-simile 
Prescriptions. 3d Edition, Revised, and with Elaborate Tables of 
Chemical Solubilities, etc. $3.00 

ROBINSON. Latin Grammar of Pharmacy and Medicine. 
3d Edition. With elaborate Vocabularies. I* 1 -75 

SAYRE. Organic Materia Medica and Pharmacognosy. An 
Introduction to the Study of the Vegetable Kingdom and the Vege- 
table and Animal Drugs. Comprising the Botanical and Physical 
Characteristics, Source, Constituents, and Pharmacopeial Prepar- 
ations. With Chapters on Synthetic Organic Remedies, Insects 
Injurious to Drugs, and Pharmacal Botany. A Glossary and 543 
Illustrations. Second Edition. Preparing. 

SCOVILLE. The Art of Compounding. Second Edition, Re- 
vised and Enlarged. Cloth, $2.50; Sheep, $3.50 

STEWART. Compend of Pharmacy. Based upon " Reming- 
ton's Text-Book of Pharmacy " 5th Edition, Revised in Accord- 
ance with the U. S. Pharmacopoeia, 1890. Complete Tables of 
Metric and English Weights and Measures. .80; Interleaved, $1.25 

UNITED STATES PHARMACOPOEIA. 1890. 7 th Decennial 
Revision. Cloth, $2.50 (postpaid, $2.77); Sheep, $3.00 (postpaid, 
$3.27); Interleaved, $4.00 (postpaid, $4.50); Printed on one side of 
page only, unbound, $3.50 (postpaid, $3.90). 

Select Tables from the U. S. P. (1890). Being Nine of the Most 
Important and Useful Tables, Printed on Separate Sheets. Care- 
fully put up in patent envelope. .25 

POTTER. Hand-Book of Materia Medica, Pharmacy, and 
Therapeutics. 600 Prescriptions. 7th Ed. Clo.,$5.oo; Sh., $6.00 

*** Special Catalogue 0/ Books on Pharmacy free upon application. 

PHYSICAL DIAGNOSIS. 

BROWN. Medical Diagnosis. A Manual of Clinical Methods. 

4th Ed. 112 Illustrations. Just Ready ', Cloth, $2.25 

FENWICK. Medical Diagnosis. 8th Edition. Rewritten and 

very much Enlarged. 135 Illustrations. Cloth, $2.50 

MEMMINGER. Diagnosis by the Urine. 2d Ed. 24 Illus. $1 00 

TYSON. Hand-Book of Physical Diagnosis. For Students and 
Physicians. By the Professor of Clinical Medicine in the University 
of Pennsylvania.* Illus. 3d Ed., Improved and Enlarged. With 
Colored and other Illustrations. Just Ready. $i-5o 

2 



18 SUBJECT CATALOGUE. 

PHYSIOLOGY. 

BRUBAKER. Compend of Physiology. 9th Edition, Revised 
and Enlarged. Illustrated. Just Ready. .80; Interleaved, $1. 25 

KIRKE. Physiology. (15th Authorized Edition. Dark-Red Cloth.) 
A Hand-Book of Physiology. 15th Edition, Revised, Rearranged, 
and Enlarged. By Prof. W. D. Halliburton, of Kings College, 
London. 661 Illustrations, some of which are printed in colors. 
Just Ready. Cloth, $3.00; Leather, $3.75 

LANDOIS. A Text-Book of Human Physiology, Including 
Histology and Microscopical Anatomy, with Special Reference to 
the Requirements of Practical Medicine. 5th American, translated 
from the 9th German Edition, with Additions by Wm. Stirling, 
m.d.,d.sc. 845 Illus., many of which are printed in colors. In Press. 

STARLING. Elements of Human Physiology. 100 Ills. $1.00 

STIRLING. Outlines of Practical Physiology. Including 
Chemical and Experimental Physiology, with Special Reference to 
Practical Medicine. 3d Edition. 289 Illustrations. $2.00 

TYSON. Cell Doctrine. Its History and Present State. $1.50 

YEO. Manual of Physiology. A Text- Book for Students of 
Medicine. By Gerald F. Yeo, m.d., f.r c.s. 3d Edition. 254 
Illustrations and a Glossary. Cloth, $2. 50 ; Leather, $3.00 

PRACTICE. 

BEALE. On Slight Ailments; their Nature and Treatment. 

2d Edition, Enlarged and Illustrated. $ l -^5 

FOWLER. Dictionary of Practical Medicine. By various 

writers. An Encyclopaedia of Medicine. Clo.,$3.oo; Half Mor. #4.00 

HUGHES. Compend of the Practice of Medicine. 6th Edition, 

Revised and Enlarged. 

Part I. Continued, Eruptive, and Periodical Fevers, Diseases of the 
Stomach, Intestines, Peritoneum, Biliary Passages, Liver, Kid- 
neys, etc., and General Diseases, etc. 
Part II. Diseases of the Respiratory System, Circulatory System, 
and Nervous System; Diseases of the Blood, etc. 

Price of each part, .80; Interleaved, $1.25 
Physician's Edition. In one volume, including the above two 
parts, a Section on Skin Diseases, and an Index. 6th Revised, 
Enlarged Edition. 568 pp. Full Morocco, Gilt Edge, $2.25 

ROBERTS. The Theory and Practice of Medicine. The 
Sections on Treatment are especially exhaustive. 9th Edition, 
with Illustrations. Cloth, $4. 50; Leather, $5.50 

TAYLOR. Practice of Medicine. 5th Edition. Cloth, $4.00 

TYSON. The Practice of Medicine. By James Tyson, m.d., 
Professor of Clinical Medicine in the University of Pennsylvania. 
A Complete Systematic Text-book with Special Reference to Diag- 
nosis and Treatment. Illustrated. 8vo. 

Cloth, $5.50 ; Leather, $6.50 ; Half Russia, $7.50 

prescription books. 

BEASLEY. Book of 3100 Prescriptions. Collected from the 
Practice of the Most Eminent Physicians and Surgeons — English, 
French, and American. A Compendious History of the Materia, 
Medica, Lists of the Doses of all Officinal and Established Prepara- 
tions, and an Index of Diseases and their Remedies. 7th Ed. $2.00 



MEDICAL BOOKS. 19 



BEASLEY. Druggists' General Receipt Book. Comprising 
a Copious Veterinary Formulary, Recipes in Patent and Proprie- 
tary Medicines, Druggists' Nostrums, etc. j Perfumery and Cos- 
metics, Beverages, Dietetic Articles and Condiments, Trade Chem- 
icals, Scientific Processes, and an Appendix of Useful Tables, 
ioth Edition, Revised. $2.00 

BEASLEY. Pocket Formulary. A Synopsis ol the British, French, 
German, and United States Pharmacopoeias and the chief unofficial 
Formularies. 12th Edition. Just Ready. $2.00 

SKIN. 

BULKLEY. The Skin in Health and Disease. Illustrated. .40 

CROCKER. Diseases of the Skin. Their Description, Pathol- 
ogy, Diagnosis, and Treatment, with Special Reference to the Skin 
Eruptions of Children. 92 Illus. 3d Edition. Preparing. 

IMPEY. Leprosy. 37 Plates. 8vo. $3-50 

SCHAMBERG. Diseases of the Skin. 99 Illustrations. Being 
No. 16? Quiz-Compend? Series. Cloth, .80; Interleaved, $1.25 

VAN HARLINGEN. On Skin Diseases. A Practical Manual 
of Diagnosis and Treatment, with special reference to Differential 
Diagnosis. 3d Edition, Revised and Enlarged. With Formulae 
and 60 Illustrations, some of which are printed in colors. $2.75 

SURGERY AND SURGICAL DIS- 
EASES (see also Urinary Organs). 

CRIPPS. Ovariotomy and Abdominal Surgery. Illus. £8. 00 

DEAVER. Surgical Anatomy. A Treatise on Human Anatomy 
in its Application to Medicine and Surgery. With about 400 very 
Handsome full-page Illustrations Engraved from Original Drawings 
made by special Artists from Dissections prepared for the purpose. 
Three Volumes. Royal Square Octavo. 
Cloth, $21.00; Half Morocco or Sheep, $24.00 ; Half Russia, $27.00 

DEAVER. Appendicitis, Its Symptoms, Diagnosis, Pathol- 
ogy, Treatment, and Complications. Elaborately Illustrated 
with Colored Plates and other Illustrations. Cloth, $3.50 

DULLES. What to Do First in Accidents and Poisoning. 
5th Edition. New Illustrations. $1.00 

HACKER. Antiseptic Treatment of Wounds, According to 
the Method in Use at Professor Billroth's Clinic, Vienna. .50 

HAMILTON. Lectures on Tumors, from a Clinical Stand- 
point. Third Edition, Revised, with New Illustrations. $1-25 

HEATH. Minor Surgery and Bandaging, ioth Ed., Revised 
and Enlarged. 158 Illustrations, 62 Formulae, Diet List, etc. £1.25 

HEATH. Injuries and Diseases of the Jaws. 4th Edition. 
187 Illustrations. $4-5o 

HEATH. Lectures on Certain Diseases of the Jaws. 64 Illus- 
trations. Boards, .50 

HORWITZ. Compend of Surgery and Bandaging, including 
Minor Surgery, Amputations, Fractures, Dislocations, Surgical Dis- 
eases, and the Latest Antiseptic Rules, etc., with Differential Diagno- 
sis and Treatment. 5th Edition, very much Enlarged and Rear- 
ranged. 167 Illustrations, 98 Formulae. Clo.,.8o; Interleaved, $1.25 



20 SUBJECT CATALOGUE. 

JACOBSON. Operations of Surgery. Over 200 Illustrations. 

Cloth, $3.00; Leather, $4.00 
JACOBSON. Diseases of the Male Organs of Generation. 

88 Illustrations. $6.00 

LANE. Surgery of the Head and Neck, no Illustrations. 
2d Edition. Just Ready. $5.00 

MACREADY. A Treatise on Ruptures. 24 Full-page Litho- 
graphed Plates and Numerous Wood Engravings. Cloth, $6.00 
MAYLARD. Surgery of the Alimentary Canal. 134 lllus. $7.50 

MOULLIN. Text-Book of Surgery. With Special Reference to 
Treatment. 3d American Edition. Revised and edited by John B. 
Hamilton, m.d., ll.d., Professor of the Principles of Surgery and 
Clinical Surgery, Rush Medical College, Chicago. 623 Illustrations, 
over 200 of which are original, and many of which are printed in 
colors. Handsome Cloth, $6.00; Leather, $7.00 

" The aim to make this valuable treatise practical by giving special 

attention to questions ot treatment has been admirably carried out. 

Many a reader will consult the work with a feeling of satisfaction that 

his wants have been understood, and that they have been intelligently 

met." — The American Journal of Medical Science. 

ROBERTS. Fractures of the Radius. A Clinical and Patho- 
logical Study. 33 Illustrations. $1.00 

SMITH. Abdominal Surgery. Being a Systematic Description ot 
all the Principal Operations. 224 lllus. 6th Ed. 2 Vols. Clo., $10.00 

SWAIN. Surgical Emergencies. Fifth Edition. Cloth, $1.75 

VOSWINKEL. Surgical Nursing. Second Edition, Revised and 
Enlarged. 111 Illustrations, fust Ready. $1.00 

WALSHAM. Manual of Practical Surgery. 6th Ed., Re- 
vised and Enlarged. With 410 Engravings. #3-o° 

'WATSON. On Amputations of the Extremities and Their 
Complications. 250 Illustrations. $5-5o 

THROAT AND NOSE (see also Ear). 

COHEN. The Throat and Voice. Illustrated. .40 

HALL. Diseases of the Nose and Throat. Two Colored 

Plates and 59 Illustrations. $2.50 

HOLLOPETER. Hay Fever. Its Successful Treatment. $1.00 

HUTCHINSON. The Nose and Throat. Including the Nose, 

Naso- Pharynx, Pharynx, and Larynx. Illustrated by Lithograph 

Plates and 40 other Illustrations. 2d Edition. In Press. 

MACKENZIE. Pharmacopoeia of the London Hospital for 
Dis. of the Throat. 5th Ed., Revised by Dr. F. G. Harvey. $1.00 

McBRIDE. Diseases of the Throat, Nose, and Ear. A Clinical 
Manual. With colored lllus. from original drawings. 2d Ed. $6.00 

POTTER. Speech and its Defects. Considered Physiologically, 
Pathologically, and Remedially. £1.00 

URINE AND URINARY ORGANS. 

ACTON. The Functions and Disorders of the Reproductive 
Organs in Childhood, Youth, Adult Age, and Advanced Life, 
Considered in their Physiological, Social, and Moral Relations. 
8th Edition. $1.75 



MEDICAL BOOKS. 21 



ALLEN. Albuminous and Diabetic Urine. Illus. $2.25 

BEALE. One Hundred Urinary Deposits. On eight sheets, 

for the Hospital, Laboratory, or Surgery. Paper, $2.00 

HOLLAND. The Urine, the Gastric Contents, the Common 
Poisons, and the Milk. Memoranda, Chemical and Microscopi- 
cal, for Laboratory Use. Illustrated and Interleaved. 5th Ed. $1.00 

JACOBSON. Diseases of the Male Organs of Generation. 88 
Illustrations $6.00 

MEMMINGER. Diagnosis by the Urine. 2d Ed. 24 Illus. $1.00 

MORRIS. Renal Surgery, with Special Reierence to Stone in the 
Kidney and Ureter and to the Surgical Treatment of Calculous 
Anuria. Illustrated. $2 00. 

MOULLIN. Enlargement of the Prostate. Its Treatment and 
Radical Cure. 2d Edition. Illustrated. In Press. 

MOULLIN. Inflammation of the Bladder and Urinary Fever. 
Octavo. J list Ready. $1.50 

THOMPSON. Diseases of the Urinary Organs. 8th Ed. $3.00 

TYSON. Guide to Examination of the Urine. For the Use of 
Physicians and Students. With Colored Plate and Numerous Illus- 
trations engraved on wood. 9th Edition, Revised. $1.25 

VAN NUYS. Chemical Analysis of Healthy and Diseased 
Urine, Qualitative and Quantitative. 39 Illustrations. #1.00 

VENEREAL DISEASES. 

COOPER. Syphilis. 2d Edition, Enlarged and Illustrated with 

20 full-page Plates. $5.00 

GOWERS. Syphilis and the Nervous System. 1.00 

VETERINARY. 

ARMATAGE. The Veterinarian's Pocket Remembrancer. 
Being Concise Directions for the Treatment of Urgent or Rare Cases, 
Embracing Semeiology, Diagnosis, Prognosis, Surgery, Treatment, 
etc. 2d Edition. Boards, $1.00 

BALLOU. Veterinary Anatomy and Physiology. 29 Graphic 
Illustrations. .80; Interleaved, $1.25 

TUSON. Veterinary Pharmacopoeia. Including the Outlines of 
Materia Medica and Therapeutics. 5th Edition. $2.25 

WOMEN, DISEASES OF. 

BYFORD (H. T.). Manual of Gynecology. Second Edition, 
Revised and Enlarged by 100 pages. With 341 Illustrations, many 
of which are from original drawings. $3.00 

BYFORD (W. H.). Diseases of Women. 4th Edition. 306 
Illustrations. Cloth, $2.00 

DUHRSSEN. A Manual of Gynecological Practice. 105 
Illustrations. ^J-So 

LEWERS. Diseases of Women. 146 Illus. 5th Ed. $2.50 

WELLS. Compend of Gynecology. Illustrated. 

.80; Interleaved, $1.25 

FULLERTON. Nursing in Abdominal Surgery and Diseases 
of Women 2d Edition. 70 Illustrations. I1.50 



SUBJECT CATALOGUE. 



COMPENDS. 



From The Southern Clinic. 

" We know of no series of books issued by any house that so fully 
meets our approval as these ? Quiz-Compends?. They are well ar- 
ranged, full, and concise, and are really the best line of text-books that 
could be found for either student or practitioner." 



BLAKISTON'S ? QUIZ-COMPENDS? 

The Best Series of Manuals for the Use of Students. 
Price of each, Cloth, .80. Interleaved, for taking Notes, $1.25. 

4GJ* These Compends are based on the most popular text-books 
and the lectures of prominent professors, and are kept constantly re- 
vised, so that they may thoroughly represent the present state of the 
subjects upon which they treat. 

&§~ The authors have had large experience as Quiz-Masters and 
attaches of colleges, and are well acquainted with the wants of students. 

JfcS" They are arranged in the most approved form, thorough and 
concise, containing over 600 fine illustrations, inserted wherever they 
could be used to advantage. 

4^* Can be used by students of any college. 

&$~ They contain information nowhere else collected in such a 
condensed, practical shape. Illustrated Circular free. 

No. 1. POTTER. HUMAN ANATOMY. Sixth Revised and 
Enlarged Edition. Including Visceral Anatomy. Can be used 
with either Morris's or Gray's Anatomy. 117 Illustrations and 16 
Lithographic Plates of Nerves and Arteries, with Explanatory 
Tables, etc. By Samuel O. L. Potter, m.d., Professor of the 
Practice of Medicine, Cooper Medical College, San Francisco ; late 
A. A. Surgeon, U. S. Army. 

No. 2. HUGHES. PRACTICE OF MEDICINE. Part I. Sixth 
Edition, Enlarged and Improved. By Daniel E. Hughes, m.d., 
Physician-in-Chief, Philadelphia Hospital, late Demonstrator ot 
Clinical Medicine, Jefferson Medical College, Phila. 

No. 3. HUGHES. PRACTICE OF MEDICINE. Part II. 
Sixth Edition, Revised and Improved. Same author as No. 2. 

No. 4. BRUBAKER. PHYSIOLOGY. Ninth Edition, with 
new Illustrations and a table of Physiological Constants. Enlarged 
and Revised. By A. P. Brubaker, m.d., Professor of Physiology 
and General Pathology in the Pennsylvania College of Dental 
Surgery ; Adjunct Professor of Physiology, Jefferson Medical 
College, Philadelphia, etc. 

No. 5. LANDIS. OBSTETRICS. Sixth Edition. By Henry G. 
Landis, m.d. Revised and Edited by Wm. H. Wells, m.d., 
Instructor of Obstetrics, Jefferson Medical College, Philadelphia. 
Enlarged. 47 Illustrations. 

No. 6. POTTER. MATERIA MEDICA, THERAPEUTICS, 
AND PRESCRIPTION WRITING. Sixth Revised Edition 
(U. S. P. 1890). By Samuel O. L. Potter, m.d., Professor of 
Practice, Cooper Medical College, San Francisco ; late A. A. Sur- 
geon, U. S. Army. 



MEDICAL BOOKS. 23 



PQUIZ-COMPENDS ?— Continued. 

No. 7. WELLS. GYNECOLOGY. By Wm. H. Wells, m.d., 
Instructor of Obstetrics, JeffersoD College, Philadelphia. 150 Illus- 
trations. 

No. 8. GOULD AND PYLE. DISEASES OF THE EYE 
AND REFRACTION. A New Book. Including Treatment 
and Surgery, and a Section on Local Therapeutics. By George 
M. Gould, m.d., and W. L. Pyle, m.d. With Formulae, Glossary, 
Tables, and 111 Illustrations, several of which are Colored. 

No. 9. HORWITZ. SURGERY, Minor Surgery, and Bandag- 
ing. Fifth Edition, Enlarged and Improved. By Orvillb 
Horwitz, b. s., m.d. , Clinical Professor of Genito-Urinary Surgery 
and Venereal Diseases in Jefferson Medical College ; Surgeon to 
Philadelphia Hospital, etc. With 98 Formulae and 71 Illustrations. 

No. 10. LEFFMANN. MEDICAL CHEMISTRY. Fourth 

Edition. Including Urinalysis, Animal Chemistry, Chemistry of 
Milk, Blood, Tissues, the Secretions, etc. By Henry Leffmann, 
m.d., Professor of Chemistry in Pennsylvania College of Dental 
Surgery and in the Woman's Medical College, Philadelphia. 

No. 11. STEWART. PHARMACY. Fifth Edition. Based upon 
Prof. Remington's Text-Book of Pharmacy. By F. E. Stewart, 
m.d., ph.g., late Quiz-Master in Pharmacy and Chemistry, Phila- 
delphia College of Pharmacy ; Lecturer at Jefferson Medical 
College. Carefully revised in accordance with the new U. S. P. 

No. 12. BALLOU. VETERINARY ANATOMY AND PHY- 
SIOLOGY. Illustrated. By Wm. R. Ballou, m.d., Professor 
of Equine Anatomy at New York College of Veterinary Surgeons ; 
Physician to Bellevue Dispensary, etc. 29 graphic Illustrations. 

No. 13. WARREN. DENTAL PATHOLOGY AND DEN- 
TAL MEDICINE. Third Edition, Illustrated. Containing 
a Section on Emergencies. By Geo. W. Warren, dd.s., Chief 
ot Clinical Staff, Pennsylvania College of Dental Surgery. 

No. 14. HATFIELD. DISEASES OF CHILDREN. Second 
Edition. Colored Plate. By Marcus P. Hatfield, Profes- 
sor of Diseases of Children, Chicago Medical College. 

No. 15. HALL. GENERAL PATHOLOGY AND MORBID 
ANATOMY. 91 Illustrations. By H. Newberry Hall, ph.g., 
m.d., late Professor of Pathology, Chicago Post-Graduate Medi- 
cal School. Second Edition. 

No. 16. DISEASES OF THE SKIN. By Jay T. Schamberg, 
m.d., Instructor in Skin Diseases, Philadelphia Polyclinic. With 
99 handsome Illustrations. 

Price, each, Cloth, .80. Interleaved, for taking Notes, $1,25. 

In preparing, revising, and improving Blakiston's ? Quiz-Com- 
pends ? the particular wants of the student have always been kept in 
mind. 

Careful attention has been given to the construction of each sentence, 
and while the books will be found to contain an immense amount of 
knowledge in small space, they will likewise be found easy reading ; 
there is no stilted repetition of words ; the style is clear, lucid, and dis- 
tinct. The arrangement of subjects is systematic and thorough ; there 
is a reason for every word. They contain over 600 illustrations. 



Morris' 
Anatomy 

Second Edition, 
Revised and Enlarged. 

790 Illustrations, of which many 
are in Colors. 



Royal Octavo. Cloth, $6.00 ; Sheep, $7.00 ; 
Half Russia, $8.00. 



'Erotn. The Medical Record, New York. 

" The reproach that the English language can boast of no 
treatise on anatomy deserving to be ranked with the masterly 
works of Henle, Luschka, Hyrtl, and others, is fast losing 
its force. During the past few years several works of great 
merit have appeared, and among these Morris's "Anatomy " 
seems destined to take first place in disputing the palm in 
anatomical fields with the German classics. The nomencla- 
ture, arrangement, and entire general character resemble 
strongly those of the above-mentioned handbooks, while in 
the beauty and profuseness of its illustrations it surpasses 
them. . . . The ever-growing popularity of the book 
with teachers and students is an index of its value, and it 
may safely be recommended to all interested." 



*** Handsome Descriptive Circular, with 
Sample Pages and Colored Illustrations, 
will be sent free upon application. 



JUl* 



